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AHCPR Studies Suggest Quality Improvements

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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 United States.

"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 hospitals.

For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (

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