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Quality of Care

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England and the United States differ in their approaches to improving cardiac care

The United States and England have different quality improvement (QI) strategies for improving care for coronary heart disease, the leading cause of death in both countries. The strong base of health services research and local QI efforts in the United States afford many opportunities to evaluate the effectiveness of various QI strategies for improving cardiac care. However, the United States lacks comprehensive national standards and monitoring systems to determine whether cardiac care is actually improving. In contrast, national and regional standards for cardiac care have been implemented more rapidly in England, but evaluative mechanisms are still under development, according to a recent study.

John Z. Ayanian, M.D., of Harvard Medical School, and Thomas J. Quinn, a registered nurse specializing in cardiac care, of the U.K. Department of Health, reviewed and compared key QI strategies in both countries. Their review, which was supported by the Agency for Healthcare Research and Quality (HS08071 and HS09718), revealed that compliance with coronary care clinical guidelines is mandatory in England but only voluntary in the United States. National standards for cardiac care are a much more prominent QI strategy in England due to the centralized nature of health care funding and planning in the British National Health Service. Without a national health system, the United States has neither the political mandate nor the mechanisms to implement national standards for cardiac care.

In the market-based U.S. system, quality reports are viewed as more acceptable than standards to promote consumer choice and provider accountability. Statewide public release of performance reports on physicians and hospitals have focused on coronary heart disease mortality and have stimulated internal efforts by hospitals to improve quality. In England, public performance reports for CHD have been more limited, but their role is likely to increase. Benchmarking, local physician opinion leaders, and physician financial incentives are promising tools to improve quality of cardiac care in the United States and England.

More details are in "Quality of care for coronary heart disease in two countries," by Dr. Ayanian and Mr. Quinn, in the May 2001 Health Affairs 20(3), pp. 55-67.

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