By Joe Rojas-Burke, The Oregonian, Portland, Ore. Knight Ridder/Tribune Business News
Jan. 16--In a state-by-state look at the quality of medical care, Oregon scored the largest gain in ranking, jumping from 20th to 11th highest in the nation.
Researchers tracked how often caregivers met basic standards of care when facing important treatment decisions, such as prescribing aspirin quickly after a heart attack or making sure diabetics receive appropriate eye exams and blood tests. Nationwide, the study found that practitioners performed better on 20 of 22 measures of quality in 2000-01 than they did in a similar survey two years earlier.
The findings are a sign of progress in a growing movement to fix problems and systematically improve the delivery of health care. They also indicate that government agencies, employers, unions and medical groups in Oregon have been more successful in this quest than their counterparts in many other states.
'People who are working tremendously hard to give good quality health care need to be credited for bringing about measurable improvements,' said Dr. David Shute, medical director of OMPRO, a Portland-based nonprofit with federal contracts to support evidence-based health care for Medicare patients in Oregon.
The authors of the study said it also underscores how many problems remain to be fixed -- even in states such as Oregon that scored well.
'The improvement is measurable, it is substantial, and it is wide-ranging,' said Dr. Stephen Jencks, lead author and a researcher with the federal Centers for Medicare and Medicaid Services. 'At the same time, it is nowhere near enough.'
In Oregon and nationwide, for instance, the study found that:
Nearly half of patients with an irregular heart rhythm, called atrial fibrillation, went without blood-thinning drugs proven to prevent stroke.
One in five heart attack patients left the hospital without the recommended treatment with beta blocker drugs.
About 13 percent of pneumonia patients nationwide and 8 percent in Oregon waited more than 8 hours for antibiotics.
Businesses facing rapidly rising health care costs have a strong interest in seeing that the money is well spent.
The study, published Wednesday in the Journal of the American Medical Association, is one of the largest attempts to track changes in health care quality. Researchers took random samples of medical charts and billing records from thousands of episodes of care in each of the 50 states, the District of Columbia, and Puerto Rico.
But it included only records from Medicare, the federal program for people 65 and older or disabled. So the findings offer an indirect view of privately funded health care.
Still, said Shute, 'You can say things are better, they are significantly better.'
Medical caregivers in Oregon made particularly large gains in treating heart attacks, heart failure, pneumonia and diabetes, as well as in providing immunizations. The gains most likely reflect the combined efforts of health care organizations and purchasers, including employers, unions and government agencies, said Dr. Allen Johnson, who helped lead quality improvement work for Regence BlueCross BlueShield, the state's largest health insurer.
'A lot of efforts are finally paying off,' Johnson said.
The Oregon Diabetes Collaborative is one example. Sixteen medical groups across the state met regularly for a year to develop a system for identifying patients, tracking their progress and encouraging them to be active participants in care. The project got technical support from health plans and public health officials and received funding from OMPRO and two other nonprofit groups.
Hospitals also have launched systematic quality improvement projects. The goal, said Shute, 'is to make it easy for people to do the right thing and much harder to do the wrong thing.'
Like earlier surveys, the new study revealed big geographic variations in quality. The top one-fourth of performers clustered in New England, the upper Midwest and Rocky Mountains. Washington ranked 19th. The worst performers were in the Deep South.
Jencks said he thinks there are two reasons why practitioners fail to provide optimal care. Some don't know about the evidence or are unconvinced by it. He said the more important reason is that not enough hospitals and practices have established systems to ensure that the best practices are used.
The Los Angeles Times-Washington Post News Service contributed to this report.
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(c) 2003, The Oregonian, Portland, Ore. Distributed by Knight Ridder/Tribune Business News.
