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Page: << Prev | 1 | 2 | 3 | Next >> Overall, the centers affected by the intervention showed more improvement in prevention, screening and treatment measures than either the external or internal controls for quality of care for patients with asthma and diabetes, but not hypertension.
There was a 21 percent increase in foot examinations for patients with diabetes in centers participating in the program, a 14 percent increase in the use of anti-inflammatory drugs for asthma, and a 16 percent increase in testing for blood glucose.
There was no improvement in "intermediate outcomes," however -- clinical markers such as the need for urgent care or hospitalization for asthma, or the control of blood pressure for hypertension.
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"These things can be effective, but sometimes they don't work and the reasons they don't work are not always clear," Landon said.
While praising the study, Dr. Rodney Hayward, author of an accompanying editorial, pointed to bigger problems with evaluating quality of health care in this country.
"The study shows us how hard it is to achieve real high levels on some of these quality measures," said Hayward, who is director of health services research and development at the VA Ann Arbor Healthcare System and a professor of medicine and public health at the University of Michigan. "We have to better understand some of the reasons we're not at the level we wish to be."
While some point to problems with health-care quality (for example, the doctor is responsible for patients not taking their blood pressure medication), others point to consumer/patient issues (they're ultimately responsible for taking their medication correctly).
"Some measures are not necessarily a perfect reflection of quality. They're not even close to perfect," Hayward said. "If we adjust payments [to reflect those measures], we can really do some unfair things that might harm the patients that need the most attention."
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