Some U.S. Physicians Do Not Provide Highest Quality of Care Available, Study Finds

A study published Tuesday in the journal Health Affairs indicates that some physicians "are failing to provide Americans with the best care that modern medicine has to offer," the Chicago Tribune reports (Kotulak, Chicago Tribune, 5/10).

The Commonwealth Fund study, which includes survey responses from more than 1,800 physicians nationwide, found that doctors who work alone or in small practices are not as likely as other doctors to have access to devices that could improve record-keeping or reduce diagnostic mistakes (Stewart, Newark Star-Ledger, 5/10).

The following are other findings from the study.

• Three-fourths of physicians surveyed said they did not use electronic medical records and two-thirds said they were not involved in efforts to improve systems of care at the time of the survey. In addition, two-thirds of respondents said they did not monitor feedback about the quality of their clinical performance.
  
  
• Sixty-nine percent of physicians surveyed said the public should not have access to information on physician performance. However, 55% of respondents said that patients should have performance information on physicians, and 71% said that performance data should be made available to executive staff at physician practices (Chicago Tribune, 5/10).
  
  
• Most doctors who receive feedback do so through patient surveys, while 25% of physicians surveyed said they receive quality-of-care data through external sources such as health plans.
  
  
• Almost 72% of doctors surveyed cited instances when a patient's medical records, tests results or other information were not available at the time of visit.
  
  
• About 15% of doctors surveyed said that they often or sometimes observed patients with positive test results "who were not properly followed-up," the Newark Star-Ledger reports (Newark Star-Ledger, 5/10). One in 10 respondents said they often or sometimes witnessed patients receiving the wrong drug or dosage, and one out of three said some tests or procedures had to be repeated because of errors.
  
  
• Fifty-eight percent of doctors surveyed said they believed their income was tied to productivity, and about half of physicians said they would lose money by providing quality care.

The study "called on physicians to support measures to improve quality," the Tribune reports. Stephen Shoenbaum, executive vice president of the Commonwealth Fund and co-author of the report, said, "It is shocking that doctors don't know what the quality of their care is compared to their peers, are very reluctant to make such information available to their patients and the public and are not continually engaged in major efforts to improve care."

Stephen Persell of the Northwestern University Feinberg School of Medicine said, "If the medical system were a bank, you wouldn't deposit your money here because there would be an error every one in two to one in three times you made a transaction." He added, "Physicians want to perform high-quality care, but they have huge financial and cultural barriers to changing their practice. Without a major external motivation, they're not going to be able to make big improvements in health care quality" (Chicago Tribune, 5/10).

The study is available online.