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Media Advisory Date: November 18, 1997
Five new papers supported by the Agency for Health Care
Policy and Research (AHCPR) and published in the November 19
issue of the Journal of the American Medical Association (JAMA),
present findings and suggestions that could be used to improve
the quality of medical care. The papers are:
"Choice of a Personal Physician and Patient Satisfaction in
an HMO"—This study by Julie Schmittdiel, M.A., of Kaiser
Permanente's Division of Research, and others, found that
patients of a large group model HMO who were allowed to chose
their primary care physician were much more satisfied with their
care than patients of the same HMO who were randomly assigned to
a doctor. The authors say the results suggest that even in a
setting of limited physician choice, the opportunity to select
one's personal doctor may influence satisfaction.
"Implementation of Clinical Guidelines via a Computer
Charting System: Effect on the Initial Care of Health Care
Workers Exposed to Body Fluids"—David L. Schriger, M.D., and
fellow researchers found that integrating an experimental
software program of guideline-based advice for emergency room
physicians on testing and treating persons exposed to potentially
dangerous body fluids with the electronic patient record system
of a large medical center increased quality of care and reduced
costs. According to the researchers, their program could be made
available to doctors via the Internet at a cost the first year of
just 33 cents per person for the approximately 300,000 exposures
to potentially dangerous body fluids that occur each year in the
"The Future of Quality Measurement and Management in a
Transforming Health System"—Author David Blumenthal, M.D.,
predicts that over the next 10 to 20 years, the Internet will be
largely responsible for assuring and improving health care
quality, while at the same time preserving and even enhancing the
autonomy of health providers.
"Health Care Quality: Consumer Perspectives"—Paul D.
Cleary, Ph.D., and Susan Edman-Levitan, P.A., say major
challenges to improving the quality of health care from the
consumer's perspective include collecting information from
representative samples of diverse consumers about the value they
place on different types of quality information, and conducting
research on how well different types of consumers understand and
interpret quality indicators.
"The Risks of Risk Adjustment"—Harvard Medical School's
Lisa I. Iezzoni, M.D., concludes after studying severity measures
used to produce comparisons of risk-adjusted hospital death
rates, that severity of illness does not explain differences in
death rates across hospitals. Dr. Iezzoni says that different
severity measures frequently produce different impressions about
relative hospital performance and severity-adjusted mortality
rates alone are unlikely to isolate quality differences across
For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).