Describe the inequities of medical care.

Define Health services research• Define small area analysis• Define Outcome research• Define the “Field of Dreams” effect• Describe the variations in medical practice• Describe the role of Agency for Health Care Research and Quality• Identify Medical Errors and its importance• Describe the inequities of medical care• Describe the relative importance of medical care for public healthThe above will be demonstrated by completing and submitting the assignments and by participating in the discussion(s) assigned to this chapter.MAJOR THEMES1. Health services research studies the effectiveness, efficiency, and equity of the medical care system.2. Small area analysis found that many medical procedures that are done at very high rate in some communities are much less commonly done in other, similar communities. These findings called attention to the fact that many aspects of medical practice lack a scientific basis, a problem that health services research addresses.3. Variations in medical practice are greater for medical conditions about which evidence is lacking on which treatments have the best outcome. For many conditions, more than one treatment may be appropriate, and variations occur because of different practice styles.4. Availability of services in a community influences practice styles. If there are more surgeons, more surgery is done; more hospital beds lead to more hospitalizations. Patients do not appear to be helped or harmed by some of these differences, but they make a large difference in costs.5. Outcomes research is the epidemiologic study of medical care. It reviews the records of patients with a specific diagnosis, sometimes interviewing patients later, looking for evidence of which treatments are more effective in preventing the need for further treatment and which have fewer side effects. Medicare records are a good source of information.6. Medical errors are estimated to account for up to 98,000 deaths each year, according to an Institute of Medicine report. Most of these errors occur because of failures in the system caused by fragmentation and miscommunication. The Institute of Medicine recommended that the medical system develop safety improvement methods similar to those of the commercial airline industry. 7. Health services research can be used to evaluate the quality of managed care plans, enabling employers and employees to choose the best plans. The National Committee for Quality Assurance accredits managed care plans, rating their performance by various standards.8. Health services research has documented inequities in medical care, finding that black Americans receive poorer care than whites even when they have equivalent health insurance.9. Health services research has shown that removing financial barriers to medical care can substantially improve the health of the poor and chronically ill. Much of the money spent on wealthier Americans does not contribute to better health.IMPORTANT TERMSSmall area analysis – examination of variations in medical practice patterns bygeographical areaHealth services research – research on the effectiveness, efficiency, and equity of medicalcareOutcomes research – study of the outcomes of various diagnostic and treatmentapproaches in the everyday practice of medicine; the epidemiologic study ofmedical careAgency for Healthcare Research and Quality (AHRQ) – federal agency that supportsresearch on medical careNational Committee for Quality Assurance (NCQA) – accrediting agency for managedcare plansFURTHER READINGS AND WEB SITES1. Dartmouth Atlas of Health Care web site: www.dartmouthatlas.org See especially the lecture on practice variations by John E. Wennberg at the New York Academy of Sciences, January 24, 2005.2. Institute of Medicine, To Err Is Human: Building a Safer Health System (Washington, DC: National Academies Press, 1999)3. Agency for Healthcare Research and Quality web site: www.ahrq.gov See especially AHQR Research Activities, available online.