Keeping up with quality

It is difficult to fathom that a health-care system that consumes 17 percent of a nation’s economy only delivers 55 percent of recommended care. However, delivering all of the recommended preventive care and chronic-disease management would require physicians to work 17 hours a day on only those.

There are several barriers to adopting medical evidence as the standard for treatment, including the difficulty of changing physician practice patterns and the sheer volume of research. Translating science into medical practice takes an average of 17 years, and monitoring the more than 10,000 randomized, controlled trials published annually is impossible for a busy clinician.

The research findings also change at a dizzying pack. An Archives of Internal Medicine study found that 13 percent of research articles published in the New England Journal of Medicine in 2009 were reversals of earlier research findings about prescription medications, screening tests and procedures.

A separate Journal of the American Medical Association article examined studies that found a particular medical practice effective. One-third were later followed by trials that found those practices either ineffective or less effective than originally reported.

Some of this research makes its way into guidelines created by government agencies and medical associations. The U.S. Department of Health and Human Services lists more than 7,000 guidelines on one of its websites.

 However, some of these guidelines are no more than opinion. For example, a 2011 study in Archives of Internal Medicine found that only 1 of every 7 treatment recommendations from the Infectious Diseases Society of America were based on high-quality clinical data. More than half of the more than 4,200 recommendations were based on opinion or anecdotal evidence.

About 20 members of three federal panels developing public health guidelines for obesity, hypertension and cholesterol were told to disqualify themselves from voting on crucial issues because they were too closely tied to companies that had a stake in the panels’ recommendations.