Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [130]
212 Those who seek to standardize care base their argument largely on a study from the RAND Corporation claiming that on average, Americans receive only some 55 percent of “recommended care.” The specific aspects of “recommended care” were designated by committees of “experts” convened by RAND. The RAND researchers then compared the expert recommendations with clinical practice in the United States, the latter assessed from retrospectively reviewing patient medical records. The RAND study has been criticized for relying on incomplete medical records and asserting that recommended care was essential to patient welfare when many of the recommendations were not proven to better health. Also recall how quickly recommendations of expert committees like the ones convened by RAND become outdated. See the original RAND study: Elizabeth A. McGlynn et al., “The quality of health care delivered to adults in the United States,” NEJM 348 (2003), pp. 2635–2645. Flaws in the study: Correspondence to Elizabeth A. McGlynn et al., “Quality of Health Care Delivered to Adults in the United States,” NEJM 349 (2003), pp. 1866–1868. A subsequent study from Harvard researchers who implemented the care similar to that recommended by RAND in a real-world setting found no improvement in health outcomes of diabetes, asthma, and hypertension: Bruce E. Landon et al., “Improving the management of chronic disease at community health centers,” NEJM 356 (2007), pp. 921–934. Commentary by Dr. Rodney Hayward on the failure of the RAND measures to succeed: Rodney A. Hayward, “Performance measurement in search of a path,” NEJM 356 (2007), pp. 951–953. The report of expert recommendations becoming outdated: Kaveh G. Shojania et al., “How quickly do systematic reviews go out of date? A survival analysis,” Ann Intern Med 147 (2007), pp. 224–233. Despite these cogent and long-standing criticisms of the RAND study published in 2003, the “fact” that Americans receive only some 55 percent of recommended care is widely quoted in presentations to the Congress and in the media: “What is health care quality and who decides?” Statement of Carolyn Clancy Before the Subcommittee on Health Care, March 18, 2009, Committee on Finance, U.S. Senate, http://www.ahrq.gov/news/test031809.htm; Donald Berwick et al., “Even good medical standards don’t apply in all cases,” Letters to the Editor, Wall Street Journal, April 15, 2009. Also see Jerome Groopman, Pamela Hartzband, “Sorting fact from fiction on health care,” Wall Street Journal, August 31, 2009. Other recent studies showing failure of standardized quality measures to improve health outcomes, despite linkage of compliance with the measures to physician and hospital payment: Lauren H. Nicholas et al., “Hospital process compliance and surgical outcomes in Medicare beneficiaries,” Archives of Surgery 145 (2010), pp. 999–1004; Charles D. Mabry, “Say it ain’t so, Joe,” Archives of Surgery 145 (2010), pp. 1004–1005. Also see Robert H. Brook, “The end of the quality improvement movement: Long live improving value,” JAMA 304 (2010), pp. 1831–1832.
213 Studies on the use of so-called alternative and natural therapies in the United States: David Eisenberg et al., “Trends in alternative medicine use in the United States, 1990–1997: Results of a follow-up national survey,” JAMA 280 (1998), pp. 1569–1575.
Selected Bibliography
Abramson, J., and J. M. Wright. “Are lipid-lowering guidelines evidence-based?” Lancet 369 (2007): 168–169.
Adams, John L., Ateev Mehrotra, J. William Thomas, and Elizabeth A. McGlynn. “Physician cost profiling: Reliability and risk of misclassification.” New England Journal of Medicine (NEJM) 362 (2010): 1014–1021.
Action to Control Cardiovascular Risk in Diabetes Study Group. “Effects of intensive glucose lowering in Type 2 diabetes.” NEJM 358 (2008): 2545–2559.
ADVANCE Collaborative Group. “Intensive blood glucose control and vascular