2006 May 07 Sunday
Patients Overestimate Quality Of Medical Care
Why does the medical marketplace work so poorly? Many patients have no idea how good or bad the quality of care is that they are receiving.
Patients' ratings of their medical care do not substitute for evaluations of the technical quality of that care, according to a study issued today by researchers from the RAND Corporation, UCLA and the U.S. Department of Veterans Affairs Healthcare System.
The study is the first to compare patients' own reports about the quality of their medical care with a comprehensive evaluation of their medical records.
Researchers studying vulnerable older patients found that while patients on average rated the quality of their medical care a 9 on a 10-point scale, comprehensive reviews of their medical records found they received recommended care just 55 percent of the time.
“Patients' ratings of health care are easy to obtain and report, but our findings suggest they do not accurately measure the technical quality of medical care,” said Dr. John T. Chang, a UCLA physician and lead author of the study. “If we want to understand the technical quality of health care, then we need to look at medical records.”
The findings provide additional insights into developing measurements of quality care at the health plan level. The study found that patients' views about the quality of their medical care was closely related to the quality of communications provided by their health providers, which is one dimension of the quality medical care.
The study was led by researchers from RAND Health, the David Geffen School of Medicine at UCLA and the Greater Los Angeles Veterans Affairs Healthcare System and is published in the May 2 edition of the Annals of Internal Medicine.
We need to find ways to achieve a few things to imrpove the quality of medical care using market forces:
- Have more medical care bought directly by patients. Dental care and plastic surgery are examples of areas where much more services are bought out-of-pocket with good results. Health savings accounts would help on this one.
- Find better ways for patients to know about the quality of medical care received. How to achieve this? Could automated medical records review software be developed that would partially do this task?
- Make greater incentives for health care providers to prevent illness. This was supposed to be one of the selling points of Health Maintenance Organizations. But HMOs are not exactly popular. Perhaps Kaiser has partially achieved this goal. I doubt many other HMO-like organizations have.
Anyone have any ideas on the problem of patients who can't measure quality of care?
It's hard to be a smart consumer of services you rarely use: harder still when they're technically complex, even harder when you're sick as a dog.
Cochran beat me to it, but all those reasons and one more--trust. Patients trust their doctors a lot. Yes, medical decisions are complex, but even individuals who are intelligent enough to assess their medical care rarely do so. I don't think this is because of laziness or lack of ability, it's because we trust our doctors too much. The internet is a perfect tool to assess one's treatment but because most care is provided for the elderly, the potential hasn't yet been realized.
I rely on peer evaluations which, in the DC area, are provided by a consumer publication, Checkbook Magazine.
You mentioned HMO's and the hope that they would encourage more proactive health management. However, this report simply confirms something the HMO managers have known for a while: it is easier to baffle with bullshit than dazzle with brilliance.
If one can increase the perceived value of the product merely by talking a little talk, why go to all the expense of actual healthcare?
The busy private doctor who tells the patiences what they need doesn't get the same respect as the HMO doctor who tells them everything will be alright.
"The busy private doctor who tells the patients what they need doesn't get the same respect as the HMO doctor who tells them everything will be alright."
I don't usually watch TV but in 2004 I was in DC on a temporary job and didn't get home until late so I started checking out TV news. Every 5 minutes there were 2 or 3 advertisements for prescription drugs! I hadn't seen this before and was stunned. What this does is encourage people who have absolutely no knowledge of medicine to solicit their doctors to write prescriptions for powerful drugs. Many doctors do, as we know, even if that may not be the best thing for the patient. I suspect that it makes people feel that they are getting great care - after all, their doctor prescribed what was declared "the best medicine". It's lousy medicine and one reason that US health care costs are so high.
Most patients base their evaluations of the care they receive on very superficial things. Did they have to wait? Were the rooms nice? Was the nurse pleasant and did she come right away when called? It is very hard for a patient to judge whether a doctor or other health care professional is competent. And, of course, most patients have little knowledge of departments such as laboratory, radiology and pharmacy - they never are seen. So did the pharmacy dispense the correct medication in the proper dosage? Did the X-ray tech properly position the patient? Did the blood bank issue the right unit of blood? No way for the patient to know. Patients tend to evaluate doctors and nurses on the basis of interpersonal and communication skills - important, to be sure, but not necessarily related to overall competence.
Don't expect HMO's to do much in the way of preventive care. They know that they probably won't have the patient lomg enough to reap any benefit. For example, consider a newly diagnosed diabetic. Proper diet, weight loss and control of blood glucose will help to prevent complications. But these complications take many years to develop, and the HMO's know that they will probably not be responsible for that patient when they do occur. So most HMO's have traditionally shown little interest in long-term preventive care.