The researchers found that physician groups on average use only 32 percent of 16 recommended care management processes - which include the use of nurse case managers, programs to help patients care for their illness, disease registries, reminder systems, and feedback to physicians on their quality of care. The study, published today (Wednesday, Jan. 22) in the Journal of the American Medical Association, also found that one physician group in six uses none of these processes.
"The results suggest that Americans are not receiving care that is as good as it could and should be," said Stephen Shortell, professor and dean of UC Berkeley's School of Public Health and principal investigator of the study. "In many ways, physicians are still organized to practice medicine the way they did 100 years ago."
The researchers focused on care for asthma, congestive heart failure, depression and diabetes, which together account for 140,000 deaths and $173 billion in costs each year in the United States.
They surveyed 1,040 medical groups and independent practice associations with at least 20 physician members. The presidents, chief executive officers or medical directors of the groups took part in one-hour telephone surveys from September 2000 to September 2001.
"The processes we studied are known to improve the quality of patient care," said Dr. Lawrence Casalino, assistant professor of health studies at the University of Chicago and lead author of the paper. "Our research indicates that physician organizations are beginning to create effective processes to increase quality, but most still have a long way to go."