Americans are not getting good Health care!

NEW YORK (Reuters Health) - Americans, on average, are receiving only half the tests, treatments and medical care services recommended for them, according to results of a landmark study with damning implications for health care delivery in the U.S.

The study, reported in Thursday's New England Journal of Medicine spotlights a divide between what is considered quality care based on the latest scientific evidence and the care that Americans actually receive.

"It's the best estimate we've ever had on how the nation as a whole is doing in terms of the quality of medical care that we're getting," said lead author Elizabeth McGlynn, associate director of the think-tank RAND Health.

Dr. Donald Berwick, president and CEO of the Institute for Healthcare Improvement in Boston and a leading crusader for systemic changes in health care delivery, isn't surprised by the study's findings, which expose "very serious problems" in his view.

"This study, in my opinion, should be repeated every single year," he told Reuters Health.

Relying on both random telephone surveys and reviews of patient medical records, researchers evaluated health care delivery based on 439 indicators of quality for 30 acute and chronic conditions and preventive care. The study involved nearly 7,000 adults in 12 metropolitan markets.

Most previously published research measured quality by focusing on a single condition, a smaller number of quality indicators, a geographic area or people with a single type of insurance.

Overall, the new study shows, patients received about 55 percent of recommended care, but quality varied substantially from one medical condition to another.

Older Americans with vision-impairing thickening of the lens known as "senile cataract" faired best, receiving 78.7 percent of recommended care. Alcohol-dependent adults, by contrast, received just 10.5 percent of recommended care.

Severe deficiencies were found in the care of people suffering from some of the nation's most prevalent and costly chronic diseases. The gap affected patients with coronary artery disease (who received 68 percent of recommended care), people with high blood pressure (64.7 percent) and individuals with depression (57.7 percent).

Less than a quarter of adults with diabetes had their blood sugar measured regularly, even though poor blood-sugar control can lead to more serious health consequences, such as blindness, amputation and kidney failure. Overall, diabetics (news - web sites) received only 45.4 percent of the care they should have, based on nationally accepted standards.

"I wish American medical leaders would own up to these (deficiencies)," Berwick said in a phone interview Wednesday.

McGlynn believes fixing those problems will require some upfront investment in so-called "knowledge management systems," designed to help doctors make clinical decisions and remind them to order appropriate screenings and follow-up care, for example.

"I think that will pay off for society in the long run," she said.

But Berwick said better information systems are only part of the needed remedy. Vast improvements in quality also will require a health care system redesign, better training and management and, most of all, strong leaders willing to shepherd change.

Throwing more money at the problem definitely isn't the answer, he argued. "I don't think we need a nickel more in health care. It's just being spent in the wrong way."