Report cards grade quality of heart care

(This article was first printed in the February 2004 issue of the Harvard Heart Letter. For more information or to order, please go to www.health.harvard.edu/heart.)

Is your heart getting the medical care it deserves?

A report on the quality of health care in America suggests that at least 50,000 people died in 2003 because they didn’t get up-to-snuff treatment for high blood pressure, high cholesterol, heart attacks, and diabetes. These deaths weren’t due to medical errors or lack of access but to care that fell short of agreed-upon standards.

Efforts are under way to give those who buy health care more information about the people and organizations that deliver it. One approach uses report cards based on specific standards as a basis for comparison.

The National Committee for Quality Assurance, a private, independent, not-for-profit organization, has been making such comparisons since 1997. Its report, The State of Health Care Quality 2003, includes information on more than 500 commercial, Medicare, and Medicaid organizations that cover more than 71 million Americans.

The report lists the 10 health care organizations with the top quality scores, along with the five best in each of eight regions of the United States. Aside from showing huge regional variations, with New England at the top of the list, the numbers show disturbing differences in the practice of medicine.

Better care saves lives

The scores varied wildly in some categories. For example, in the top-scoring organizations, 74% of people had their high cholesterol under control, compared to 46% in the lowest-scoring organizations. Twenty-point differences were also seen in diabetes care and blood pressure control.

The report estimates that 57,000 lives would have been saved in 2003 if all Americans got the same quality medical care as that delivered by the top HMOs. In addition, American workers would have taken 40 million fewer sick days — half due to heart disease and diabetes — and we would have spent several billion dollars less on health care.

Because cardiovascular disease accounts for the lion’s share of the deaths, sick days, and costs, the National Committee for Quality Assurance has joined forces with the American Heart Association/American Stroke Association to track cardiovascular care. The Heart/Stroke Recognition Program will measure how doctors and doctor groups perform in terms of cholesterol and blood pressure control, aspirin use, cholesterol screening, and smoking cessation.

Those meeting or exceeding the program’s high targets will be recognized in publicized lists and included in searchable databases available to people seeking good doctors. We will let you know when this is ready for prime time.

(This article was first printed in the February 2004 issue of the Harvard Heart Letter. For more information or to order, please go to www.health.harvard.edu/heart.)

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