January 12, 2017, 2:00 PM ET: Improving the Rate of Recommended Care: Looking Back and Looking Ahead
- Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement
- Elizabeth A. McGlynn, PhD, Vice President, Kaiser Permanente Research
A little over 13 years ago, a team of researchers reported in the New England Journal of Medicine that adults in the US receive only about half the care that’s recommended to prevent, treat, and manage some 30 leading causes of illness and death. The study, by then RAND Corporation health care analyst and lead author Beth McGlynn, acted as a call to action, challenging providers to do much, much better at incorporating evidence-based practices.
Has the situation improved? Not nearly enough, according to a study first published online this past fall in the Journal of the American Medical Association’s JAMA Internal Medicine. Why that's the case is the focus of the January 12 WIHI: Improving the Rate of Recommended Care. In the spirit of January, we’ll be looking back and looking ahead, and we hope you'll tune in.
Beth McGlynn is our featured guest on the January 12 WIHI, along with IHI President Emeritus and Senior Fellow, Don Berwick. The two have devoted their careers to the uptake of evidence-based care and are eager to look into the new findings, based on outpatient care from 2002–2013. Key among the results: best practice rates to prevent stroke and heart attacks have risen, along with colon cancer screenings, while screening rates for breast and cervical cancer have declined; there's more smoking cessation counseling taking place, but rates of testing for diabetes and deploying recommended care to manage the condition have remained unchanged. The JAMA Internal Medicine study also looked at overuse and found an uptick in unnecessary prescribing of antibiotics and little change in the inappropriate use of X-rays, CT scans, and other imaging over a ten-year period.
Writing in the same issue of JAMA Internal Medicine, Dr. McGlynn notes that while the newer research uses different methodology from her own work of a decade earlier, the findings suggest that implementing recommended care continues to face formidable obstacles. And, Dr. McGlynn argues, all the focus on quality metrics and payment reform isn’t helping because they appear to be diverting attention from needed system and work flow redesign. Without the latter, she says, improvement in rates of recommended care will be limited.
Don Berwick shares these observations and concerns. He says, “For years, Beth McGlynn's research has been at the forefront helping us understand how far we have yet to go to assure every patient the benefit of truly scientific care ― as Jim Reinertsen says, ‘All the care and only the care that helps.’ The Triple Aim depends on getting that right, and assuring that the policies, payment changes, and measurements we use to encourage change are aligned to help clinicians give the reliable care they aspire to give, rather than standing in their way.”
We’re looking forward to hearing from both Don Berwick and Beth McGlynn and you, our listeners. Please join us on January 12 for the first WIHI of 2017.