Tuesday, April 18, 2006

Commonwealth Fund Report corroborates patient dissatisfaction

A recent report from the Commonwealth Fund offers statistical evidence that patients feel they are not getting treated with respect.

Key findings from the Commonwealth Fund report "Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens" include:

"Patient safety: Among sicker adults, Americans had the highest rate of receiving wrong medications or doses in the prior two years... "

"Effectiveness: The indicators of effectiveness ... were grouped into four categories: prevention, chronic care, primary care, and hospital care and coordination. ... U.S. patients fared particularly well on receipt of preventive care and care for the chronically ill,... Across the indicators of effectiveness, the U.S. ranked first ..."

"Patient-centeredness: [S]urvey questions asked patients to rate the quality of their physician care in four areas: communication, choice and continuity, patient engagement, and responsiveness to patient preference... The U.S. ranked last on nearly all aspects of patient-centeredness."

"Timeliness: Germany and the U.S. stand out among the six countries in terms of patients with health problems reporting the least difficulty waiting to see a specialist or have elective or non-emergency surgery. Yet Americans, along with Canadians, were more likely to say they waited six days or more for an appointment with a doctor or had trouble getting care on nights and weekends... "

"Efficiency: Compared with their counterparts in other countries, sicker adults in the U.S. more often reported that they visited the emergency room for a condition that could have been treated by a regular doctor had one been available and that their medical records or test results failed to reach their doctor's office in time for appointments... On measures of efficiency, the U.S. ranked last among the six countries,.."

"Equity: The U.S. scored last on seven of the nine measures of low-income patients not receiving needed care and had the greatest disparities in terms of access to care between those with below-average and above-average incomes. With low rankings on all measures, the U.S. ranked last among the six countries in terms of equity in the health care system."

"Summary and Implications
These rankings summarize evidence on measures of quality as perceived or experienced by patients. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data..."

"On four of the six domains of quality of .., the U.S. performs relatively poorly from the patients' perspective. On timeliness, the U.S. performs about average. Effectiveness was the only measure on which the U.S. system performed slightly better than the five other countries, due largely to greater use of preventive care services and better care for the chronically ill..."

"The findings suggest that, if the health care system is to perform according to patients' expectations, the U.S. will need to remove financial barriers to care and improve the delivery of care. Disparities in terms of access to services signal the need to expand insurance to cover the uninsured and to ensure that the system works well for all Americans. Based on these patient reports, the U.S. should improve the delivery, coordination, and equity of the health care system."


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