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There are three major types of quality problems in Healthcare.

(1) Variation in services - There continues to be pattern of variation in healthcare services.

These include regional variations and small-area variations. This is a clear indicator that

Healthcare practice has not kept pace with the evolving science of healthcare to ensure

Evidence-based practice in the United States.

(2) Underuse of services - Millions of people do not receive necessary care and suffer

needless complications. These add costs and reduce productivity. Each year, an estimated

18,000 people die because they don't receive effective interventions. For example - A study of Medicare patients who had suffered heart attacks found that only 21 percent of eligible patients received beta blockers. The mortality rate among patients who received

Beta blockers was 43 percent lower than it was among non recipients. AHRQ funded study examined the use of beta blockers before heart bypass surgery and found that patients who received beta blocker therapy before surgery had lower rates of death and fewer complications both during and after surgery than patients who did not receive this therapy.

(3) Overuse of Services - Each year, millions of Americans receive healthcare services that are unnecessary, increase costs and may even endanger their health. Research has shown that this occurs across all populations. For example - An analysis of hysterectomies performed on women in seven health plans found that one in six operations was Inappropriate. A study examining the use of antibiotics for treating ear infections in children on Medicaid found that expensive antibiotics were used more often than indicated.

According to the findings, if only half the prescriptions were written in 1992 for more

expensive antibiotics has been written for amoxicillin, a less expensive but equally effective antibiotic, Colorado's Medicaid program would have saved nearly $400,000 that year.

 Here are three ways to improve health care delivery.

(1)  Establish healthcare as a national priority –

a.    Provide Strong Leadership and Clear Aims for Improvement 

b.    Advance Quality Measurement and Reporting 

c.     Create Public-Private Partnerships

 (2) Strengthen the Market to Improve Quality –

a. Encourage Action by Group Purchasers  

b. Strengthen the Hand of Consumers 

c. Focus on Vulnerable Populations 

d. Promote Accountability

e. Reduce Errors and Increase Safety in Health Care

(3)  Build the Capacity to Improve Quality –

a.    Foster Evidence-Based Practice and Innovation  

b.    Adapt Organizations for Change 

c.     Engage the Health Care Workforce 

d.    Invest in Information Systems