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According to a new study published in the New England Journal of Medicine, patients receive the appropriate recommended care from health care providers only 54.9 percent of the time.

The study utilized telephone surveys in 12 metropolitan areas to identify willing participants who would provide a health history and listing of their health care providers. Those who agreed signed written consent forms so that their medical records could be reviewed.

The initial sample included 20,028 adults. Medical records were then reviewed for acute and chronic conditions that represented the leading causes of death and illness. Physicians then reviewed national guidelines and medical literature and applied that to the review of each patient's chart.

The average age of the patients in the survey was 44.7 years. Women had higher rates of visits and whites had higher visit rates than blacks. In terms of adherence to quality indicators according to condition, coronary artery disease recommended care was received only 68% of the time. Moreover, only 45% of persons presenting with a myocardial infarction (heart attack), received beta-blockers, which reduce the risk of death by 13% during the first week of treatment and 23 % over the long term.

Cerebrovascular disease patients received recommended care only 59.1% of the time and colon cancer patients received the recommended care only 53.9% of the time. Among elderly patients, only 64% had received or been offered a pneumonia vaccine when nearly 10,000 preventable deaths from pneumonia annually occur.

The study notes that only 24% of participants in the study with diabetes received three or more blood sugar tests over a two year period. This routine monitoring is essential to the assessment of the treatment and identification of complications of this disease at an early stage.

Persons with hypertension (high blood pressure) received the recommended care only 64.7% of the time. Poor blood pressure control contributes to more than 68,000 preventable deaths annually.

The authors of the study say their report is the largest and most comprehensive examination of the quality of health care in the United States. The lead author, Elizabeth McGlynn says that the study demonstrates that Americans cannot take for granted that they are getting good care.

The report's conclusion is that "These deficits, which pose serious threats to the health of the American public, persist despite initiatives by both the federal government and private health care delivery systems to improve care." The authors suggest that a key component of the potential solution will be to make information on performance available at all levels. "Making such information available will require a major overhaul of our current health information systems, with a focus on automating the entry and retrieval of key data for clinical decision making and for the measurement and reporting of quality."

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