Health Care Quality

Improving the Quality of Health Care

When MPA talks about fixing the healthcare system, we usually mean increasing access to healthcare for people who don’t have insurance and reducing costs for all of us. But beyond the soaring costs and gaps in coverage that limit people’s access to care, there is another dimension to the American healthcare crisis – uneven quality.

The quality issue is about what happens after patients make it through the door to see a doctor. Regardless of whether or not they have health coverage, patients may or may not receive high quality care. That is important to keep in mind as we work to expand access to care, because poor quality care is costing the system money that could otherwise be used to expand access. Cost, access and quality are inseparable.

The problems with quality generally fall into three buckets: First, we often provide care that’s not necessary. Second, we often provide too little of the care that is necessary. Third, too much of the care we provide is too costly, too dangerous or careless.

Many people judge the quality of care based on their relationship with their doctor. Can they get appointments when they need them? How well do their doctors seem to relate to them as individuals? What is a doctor’s demeanor during an appointment? Does the doctor engage in two-way conversations, or simply hand down a diagnosis and a prescription like a judge hands down a verdict from the bench?

But the definition of quality goes beyond the relationship between patients and doctors. Quality care is care that works, care that is safe, and care that is appropriately tailored for individual patients.

Unfortunately, study after study shows that the quality of care patients receive varies widely depending on who they are, where they live and what is known about how to treat their conditions. For example, racial and ethnic minorities often receive lower-quality care than white people. Meanwhile, some regions rely more heavily on acute care hospitals than others, delivering worse outcomes in the process. And some doctors are strong believers in costly surgical procedures to treat conditions such as severe back pain (for which there are no generally recommended care guidelines) while other doctors are strong believers in less expensive treatments.

The problem is not insignificant. National estimates show that patients have only a 50-50 chance of receiving the right care at the right time when they got to the doctor. That’s no better than the toss of a coin! Here in Maine, a 2007 Commonwealth Fund scorecard showed that half of Maine adults are not getting recommended preventive health screenings at the doctor’s office. Nationwide, studies have shown that the risk of hospital-associated injury could be as high as one in ten people, and preventable deaths could be as high as one in 300. If those rates were true in Maine, that would mean 16,371 patients injured in Maine hospitals and 546 potentially preventable deaths every year.

Clearly, there is a lot at stake. That’s why MPA is working with others in Maine to do something about the quality problem. We have joined a statewide effort called Aligning Forces for Quality (AF4Q). AF4Q is a team of people and organizations working to help Maine communities improve in the quality of health care. Over the next several years, AF4Q will improve health care by strengthening the relationship between physicians and patients, promoting an evidence-based system of care, and fostering relationships among stakeholders that will ultimately transform the culture of health care in Maine.

One of the big goals of AF4Q is to involve patients themselves in improving the healthcare system as a whole so we can be sure that all of us get the best possible healthcare when we go to the doctor. If patients don’t make their voices heard, conversations about system reform will be dominated by healthcare providers, insurance companies, and other interested parties. The most important voice at the table is patients – we are the ones who need to be saying whether the system is working or not, and how it can be made better.

That’s where MPA comes in! MPA is working with AF4Q to engage patients and families in improving the healthcare delivery system – while we continue to make sure that everyone can get into it. If you’re interested in getting involved, let us know!

Some of our partners in the effort to improve healthcare quality:
Aligning Forces for Quality: http://www.forces4quality.org/
Quality Counts: http://www.mainequalitycounts.org/
Maine Health Management Coalition: http://www.mehmc.org/
National Partnership for Women and Families: http://www.nationalpartnership.org/

Resources for healthcare quality information in Maine:
Maine Health Management Coalition: http://www.mhmc.info/
Maine Quality Forum: http://mainequalityforum.com/

Additional information:
The Links Between Cost, Quality, and Access [PDF]
Disparities in Healthcare [PDF]
Poor Quality in the Health Care System: Some Problems and Solutions [PDF]

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Maine People’s Alliance—Organizing for a Better Maine!

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