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Wednesday, 22 October 2014 17:36

MHC - Risk Factors, Diagnosis and Complications

 

 My Health Counts! Risk Factors, Diagnosis and Complications

 

Risk Factors

One out of every three people with diabetes is unaware they have this chronic condition.  The American Diabetes Association estimates that amounts to 8 million Americans.  Are you one of them?

Risk Factors for type 1 diabetes

With type 1 diabetes the pancreas abruptly stops producing insulin.  Insulin is the hormone your body uses to use the energy—glucose—found in food.  The primary risk factor for type 1 diabetes is family history.

  • Genetics and family history. Having family members with diabetes is a major risk factor. The American Diabetes Association recommends that anyone with a first-degree relative with type 1 diabetes -- a mother, father, sister, or brother -- should get screened for diabetes. A simple blood test can diagnose type 1 diabetes.
  • Diseases of the pancreas. Injury or diseases of the pancreas can inhibit its ability to produce insulin and lead to type 1 diabetes.
  • Infection or illness. A range of relatively rare infections and illnesses can damage the pancreas and cause type 1 diabetes.

Risk Factors for type 2 diabetes

  • Age greater than 45 years
  • Family history of diabetes.
  • Being overweight Inactive lifestyle (exercising less than 3 times a week)
  • Certain racial and ethnic groups –African Americans, Hispanic/Latino Americans, Asian Americans and Pacific Islanders and American Indian and Alaska Natives.
  • People with low HDL cholesterol or high triglycerides, high blood pressure.
  • Woman who had gestational diabetes or who have had a baby weighing 9 pounds or more at birth.
  • HDL cholesterol under 35 mg/dL.
  • High blood levels of triglycerides, a type of fat molecule (250 mg/dL or more).
  • High blood pressure (greater than or equal to 140/90 mmHg).
  • Metabolic syndrome (A  cluster of conditions — increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.)
  • Polycystic ovarian syndrome
  • A condition called acanthosis nigricans, which causes dark, thickened skin around the neck or armpits

Everyone over 45 should have a blood sugar (glucose) test at least every 3 years. Regular testing of blood sugar levels should begin at a younger age, and be performed more often if you are at higher risk for diabetes.

Symptoms

Symptoms of diabetes can be subtle and many of the symptoms can seem harmless. You could have diabetes for months or even years and not have any symptoms at all. The American Diabetes Association estimates that more than 6 million people in the United States alone are unaware they have the disease.

Understanding possible risks and symptoms can lead to early diagnosis and treatment—and a lifetime of better health!  If you or someone you love have one or more of these symptoms see your doctor and ask to get tested.

Blurry vision-High levels of sugar (glucose) in the blood pull fluid from your tissues, including the lenses of your eyes, affecting your ability to focus.  Left untreated, diabetes can cause serious damage to the eyes which can lead to vision loss and blindness.

Excessive thirst and increased urination-These are classic diabetes symptoms.  When you have diabetes, excessive sugar (glucose) builds up in your blood.  Your kidneys work overtime to filter and absorb the excess sugar. The sugar is excreted into you urine along with fluids drawn from your tissues.  This triggers more frequent urination, which can leave you dehydrated.  As you drink more fluids to quench your thirst, you’ll urinate even more.

Being very hungry-With diabetes, your body cannot move the sugar into your cells to be used as energy.  This leads to hunger.

Being more tired than usual-You may feel fatigued or even irritable.  Many factors contribute to this including dehydrations from increased urination and your body’s inability to use sugar for energy.

Losing weight when you are not on a diet-Diabetes keeps the sugar (glucose) in the food you eat from reaching your cells.  The excess sugar is eventually excreted in your urine.

Cuts/bruises that are slow to heal-High levels of blood sugar may impair your body's natural healing process and your ability to fight infections.

Dry skin and mouth

Frequent infections-High levels of blood sugar may impair your body's natural healing process and your ability to fight infections. For women vaginal and bladder infections are especially common.

Tingling/numbness in the hands/feet-Excess sugar in your blood can lead to nerve damage.  You may notice tingling and loss of sensation in your hands and feet, as well as burning pain in your arms, hands, legs and feet.

Keep in mind that like many people with type 2 diabetes you may have NO symptoms.

Diagnosis

Your doctor can test your blood to see if you have diabetes. There are several tests that measure the amount of glucose in your blood including:

Fasting Plasma Glucose Test —this is the simplest and fastest way to measure blood glucose and diagnose diabetes.  Your doctor will ask you to fast (having nothing to eat or drink except water) for 8-12 hours before the test.  Blood is drawn and the level of glucose in the blood is measured.

  • Results of 99/mg/dl or less is normal
  • Results of 100-125 mg/dl mean you may have pre-diabetes
  • Results of 126mg/dl or higher means that you probably have diabetes.  If your test comes back with a number of 126mg/dl or higher your doctor will repeat the test on a different day to be sure the reading is right. You are diagnosed with diabetes if your blood glucose level is 126 mg/dl or greater on two separate tests.

Oral Glucose Tolerance Test —this test measures how you body responds to a set amount of glucose (sugar) in beverage form.  The level of glucose in your blood is measured after fasting for 8-12 hours and  after drinking a sweet beverage containing 75 grams of glucose.  Your blood is tested 1, 2 and possibly three hours later.  A urine test may also be done with each blood test.

  • Results of 140mg/dl or less after 2 hours is normal
  • Results of 140-199 md/dl after two hours mean you may have pre-diabetes.
  • You are diagnosed with diabetes if your blood glucose level is 200 mg/dl or greater.

The Fasting Plasma Glucose test is the preferred test for diagnosing diabetes because of its convenience and low cost. However, it will miss some diabetes or pre-diabetes that can be found with the Oral Glucose Tolerance Test. The Fasting Plasma Glucose test is most reliable when done in the morning.

Complications

Living well with diabetes requires both good medical care and effective self-management.  The key is knowing and controlling your blood sugar levels. There is a lot that health care providers can do but you must take an active role in managing in managing your diabetes.

Poorly controlled diabetes can lead to many serious health conditions affecting nearly every organ in your body.  Complications include heart disease, stroke, high blood pressure, blindness, kidney disease, complicated pregnancy, sexual dysfunction, nerve diseases, and amputation.  If you don’t take the time for diabetes now, diabetes will make you take the time later.  Work with your doctor and other members of your health care team to decrease your risk for these complications.

Learn more about Possible Complications from the American Diabetes Association.

 

 

 

Wednesday, 22 October 2014 15:49

MHC - Types of Diabetes

 

 My Health Counts! Types of Diabetes

 

What is diabetes?

Diabetes is a disease that makes it difficult for your body to turn the food you eat into fuel. The problem is closely tied to how your body makes and uses insulin, a hormone made in your pancreas (an organ in your body).  Without insulin you cannot to take food into your body and use it as energy. With diabetes the body does not make or use insulin in the right way.

When everything is working right, here’s what happens when happens when you eat:

  • You eat, and some of the food is broken down into sugars—one of the sugars is glucose, the body’s main fuel.
  • The glucose is absorbed into the bloodstream from your stomach which makes your blood glucose (or blood sugar) levels rise.
  • When your body senses an increase in sugar, it signals your pancreas to provide insulin.
  • Insulin acts as a key “unlocking” the cells throughout your body letting the sugar in.
  • Every cell in the body uses this sugar for energy.  Glucose is necessary for your muscles to contract, for your brain to think, and for every other part of your body to work.

With diabetes, your body cannot move the sugar into your cells so it can be used as energy, so sugar builds up in your bloodstream.  If this happens and you do not take steps to control your blood glucose levels you are putting yourself at risk for many challenging health conditions. But, by taking action, you can control your blood glucose levels, manage your diabetes and live a healthy, normal life.

There are two common types of diabetes and each type is treated a little differently.

  • In type 1 diabetes, your body makes little of no insulin.
  • In type 2 diabetes, your body either doesn’t make enough insulin or it doesn’t work well.

Types of Diabetes

 

Type 1 Diabetes

People with type 1 diabetes don’t make any insulin, the hormone needed to allow sugar (glucose) to enter cells to produce energy.  It is an auto-immune disease.  An autoimmune disease results when the body’s system for fighting infection—the immune system—turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.  At present, scientists do not know exactly what causes the body’s immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved.

Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States.  It is sometimes referred to as insulin dependent or juvenile diabetes.  It develops most often in children and young adults but it can occur at any age.

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.  There's nothing you can do to prevent type 1 diabetes; there is currently no known way to prevent the disease.  Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition.

Type 2 Diabetes

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. People with type 2 diabetes either don’t make enough insulin or it doesn’t work well.  Historically this form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. In recent years however, there has been a steep increase in the number of children and teens with type 2 diabetes because of the increase in obesity among these are groups.  About 80 percent of people with type 2 diabetes are overweight.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

About 6 million people in the United States with type 2 diabetes don’t even know they have it yet.  The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms. Often, type 2 diabetes is diagnosed during a routine medical check-up from a blood test where no symptoms are present.

There's no cure for type 2 diabetes, but you can manage — or even prevent — the condition. Start by eating healthy foods, exercising and maintaining a healthy weight. If diet and exercise aren't enough, you may need diabetes medications or insulin therapy to manage your blood sugar.  Even if type 2 diabetes runs in your family, diet and exercise can help prevent the disease.  If you’ve already been diagnosed with type 2 diabetes, the same healthy lifestyle choices can help you prevent serious complications.

Eat healthy foods -- Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains.

Get more physical activity -- Aim for 30 minutes of moderate physical activity a day.

Lose excess pounds -- If you're overweight, losing 5 to 10 percent of your body weight can reduce the risk of diabetes.

 

 Overview of Type 1 and Type 2 Diabetes

 

Characteristics

Type 1 Diabetes

Type2 Diabetes

Insulin

Insulin dependent

Little or no insulin is produced by the pancreas

May or may not need insulin and may need oral medications

The pancreas produces insulin, but it may not be enough or it cannot be used by the body.

Onset

Sudden

Slow

Age

Usually begins before age 20, but can occur in adults

Usually begins after age 40, but can occur earlier

Sex

Males and females equally affected

More females are affected

Heredity

Some heredity tendancy

Strong heredity tendancy

Weight

Majority experience weight loss and are thin

Majority are overweight

Ketones

Ketones found in the urine

Usually there are no ketones in the urine

Treatment

Insulin, diet, exercise, self-management

Diet, exercise, self-management, and when necessary, oral medication and/or insulin

 

 

 

Pre-diabetes

57 million people in the United States are estimated to have pre-diabetes.  People with blood glucose levels that are higher than normal but not yet high enough to be diagnosed with type 2 diabetes are defined as having pre-diabetes.  If a person does not make changes to their lifestyle and diet they will develop type 2 diabetes in ten years or less.  And if you have pre-diabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting.

The ball is in your court.  The progression of pre-diabetes to type 2 diabetes is not inevitable.  With healthy lifestyle changes including eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight you may be able to get your blood sugar level back to normal.  And you’ll feel a lot better too.

The exact cause of pre-diabetes is unknown, although researchers have discovered some genes that are related to insulin resistance. Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of pre-diabetes. What is clear is that people who have pre-diabetes aren't quite processing sugar (glucose) properly anymore.  

The American Diabetes Association recommends blood glucose screening if you have any risk factors for pre-diabetes. This includes if:

  • You're overweight, with a body mass index above 25 You're inactive You're age 45 or older
  • You have a family history of type 2 diabetes You're African-American, Hispanic, American Indian, Asian-American or Pacific Islander
  • You have a history of gestational diabetes or have given birth to a baby who weighed more than 9 pounds (4.1 kilograms)
  • You have a history of polycystic ovary syndrome
  • You have high blood pressure
  • You have abnormal cholesterol levels, including an HDL cholesterol below 35 mg/dL (0.9 mmol/L) or triglyceride level above 250 mg/dL (2.83 mmol/L)

Gestational Diabetes

Gestational diabetes is a type of diabetes that occurs only during pregnancy. Like other forms of diabetes, gestational diabetes affects the way your body uses sugar (glucose) — your body's main source of fuel.   Most women who have gestational diabetes can work with their health care team and deliver healthy babies. However, gestational diabetes that's not carefully managed can lead to uncontrolled blood sugar levels and cause problems for you and your baby.   You can manage gestational diabetes by eating healthy foods, exercising regularly and, if necessary, taking medication.  Fortunately, blood sugar levels typically return to normal soon after delivery.  Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2. Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes in the next 5–10 years. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes.

Diabetes Statistics for the United States

  • 17.9 million people are diagnosed with diabetes
  • 5.7 million people are undiagnosed with diabetes
  • 57 million people have pre-diabetes
  • 186,300 (0.22%) people under 20 have diabetes
  • 1 in every 400 to 600  under 20-year olds  have Type 1 diabetes
  • 2 million adolescents have pre-diabetes
  • 23.5 million (10.7%) of those over 20 have diabetes
  • 12.2 million of those over 60 have diabetes
  • 12 million men (11.2%) have diabetes
  • 11.5 million women (10.2%) have diabetes

American Diabetes Association, 2007

 

 


Wednesday, 22 October 2014 15:13

MHC - Where to Find Information on Quality

 

 My Health Counts! Where to Find Information on Quality

 

One of the most powerful forces driving improvement in health care is the educated consumer.

Consumers who make informed choices and are engaged in their own care not only experience better health outcomes, they also help reward doctors, hospitals and health plans that deliver better care and service. [i] To make sure you and your family get good quality care, you need to be actively involved in finding and using information that tells about health care quality.

Finding and using information about quality care can help you stay healthy and help you make good decisions about treatment when you need it. Below are resources that tell more about what you can do to help make sure that you and your family are getting good quality care.

Materials You Can Print

Resources for "Quality" Information

www.ahrq.gov – sponsored by the Agency for Healthcare Research and Quality. Click on “Consumers & Patients” to find information and resources on quality of care, medical errors and patient safety, various clinical conditions, prevention and wellness, prescription medicines, smoking cessation, choosing a health plan, and many other topics. Call the AHRQ Publications Clearinghouse at 1-800-358-9295.

www.guideline.gov – sponsored by the Agency for Healthcare Research and Quality. Quality Tools is a clearinghouse of practical, ready-to-use tools for measuring and improving the quality of health care. Information is provided for patients and consumers, health care providers, policymakers, and payers and purchasers.

www.nih.gov – sponsored by the National Institutes of Health (NIH), the government's primary source for conducting and funding clinical research. This is the main NIH website through which you can access information on many health topics and link to the various Institutes that make up the NIH. These include the National Cancer Institute, the National Heart, Lung, and Blood Institute and many others. Click on “Institutes” or search the Web site for your topic.

clinicaltrials.gov – sponsored by the National Institutes of Health provides regularly updated information about federally and privately supported research in human subjects. You can browse the site or enter specific location, condition, or other search topic.

www.medicare.gov – sponsored by the Center for Medicare & Medicaid Services can help you compare hospitals and nursing homes in your area. Phone 1-800-MEDICARE.

www.healthfinder.gov – sponsored by the U.S. Department of Health and Human Services. It offers links to hundreds of sites on the internet that contain reliable health care information. Click on “Health Care” and then “Health Care Quality” for links to many government and nongovernment sources of information on health care quality.

www.jcaho.org – sponsored by the Joint Commission on Accreditation of Healthcare Organizations. Click on “Quality Check” to locate JCAHO accredited hospitals, assisted living facilities, laboratories, and other types of health care facilities and services in your area. Phone 1-630-792-5000.

www.ncqa.org – sponsored by the National Committee for Quality Assurance. Click on “Report Cards” to access a variety of health care quality information, including reports on health care quality, report cards for physicians and health plans and more. Phone 1-888-275-7585.

www.ahqa.org – sponsored by the American Health Quality Association (AHQA). AHQA represents the national network of Quality Improvement Organizations (QIOs) that helps physicians, hospitals, health plans, nursing homes and home health agencies improve the quality of care they deliver. QIOs focus on the adoption of best practices to provide safe, effective and patient centered care. Go to www.ahqa.org/quality-improvement-organizations/whats-next-for-qios to locate a QIO near you or find out more about health care quality.

www.nahc.org – sponsored by the National Association for Home Care and Hospice. Click on “Consumers” to located home care, hospice services and other resources in your state. Phone 1-202-547-7424.

www.aaahc.org – sponsored by the Accreditation Association for Ambulatory Health Care. Click on “Search for Accredited Organizations” to locate outpatient health care services, such as freestanding surgery centers, radiology facilities, podiatrists, pain management clinics and many other types of outpatient facilities accredited by the Association. Phone 1-847-853-6060.

www.ama-assn.org – sponsored by the American Medical Association. Click on “For Patients” to access “DoctorFinder” with information about virtually every licensed physician in the United States , as well as links to other helpful web sites. Phone 1-800-621-8335.

www.docboard.org – sponsored by the National Organization for State Medical and Osteopathic Board Executive Directors. Click on “DocFinder” to access the physician database, which contains information from state government licensing board on the licensing background and disciplinary information of physicians and other health care providers.

www.fsmb.org – sponsored by the Federation of State Medical Boards. The Federation collects information on disciplinary actions taken against physicians by regulatory and licensing agencies, such as state medical boards, the National Board of Medical Examiners, various Federal agencies and other licensing authorities. Click on “Public Access” to search the web site to learn if your physician has any disciplinary history. Phone 1-817-868-4000.

www.naic.org – sponsored by the National Association of Insurance Commissioners. Click on “Consumer Information Source” and then “Health Insurance” to access information about the different types of health insurance, you rights as a consumer, consumer fact sheets and other information. Phone 1-816-842-3600.

[i] National Committee for Quality Assurance Web site. “The Basics: Public Reporting.“ (assessed Oct. 24, 2008).

 

 

 

 

Wednesday, 22 October 2014 14:38

MHC - More About Partnering With Your Doctor

 

 My Health Counts! More About Partnering With Your Doctor

 

For many people, having quality care means getting peace of mind, beginning with their relationship with their doctor. The key is finding the right doctor—one who values relationships based on openness and trust and provides high quality care.

Quality care is care that works, is safe and is tailored for patients. The federal Agency for Health Care Research and Quality defines quality care as “doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results.” [i]

Quality health care is: [ii]

  • Safe: It does not injure patients; it is supposed to help.
  • Effective: It is based on sound science to all who can benefit and refrains from providing services to those who cannot.
  • Patient-centered: It is respectful of and responsive to patients' preferences, needs and values.
  • Timely: It reduces waiting time and potentially harmful delays.
  • Efficient: It does not waste resources.
  • Equitable: It does not vary because of someone's race, gender, income or location.

“I tell groups of patients you're in charge of your own health,” says Dr. Michael Parkinson, President of the American College of Preventive Medicine. “I oftentimes say the new role of physicians, my colleagues, should be that of a Sherpa. I'm not going to climb your mountain, but I will help you climb your mountain to get healthier, to understand your medications, to help prevent unnecessary hospital admissions or complications from drugs you don't need to be on. I'm going to help you, and you need to help yourself. It starts with you being informed, and there are some very simple things you can do to begin on that journey to become a more informed patient and increase the likelihood of safe and effective care.”

So, how do you build a good partnership with your doctor? Talk to your doctors about your goals. At your next appointment say, “I want to take a more active role in my health and healthcare. Are you ready to work with me on this partnership?”

Let your Doctor be your teacher and guide. Prepare for every doctor's visit.

  • Prepare for every appointment. Know your symptoms. When did it start? What is the location? Is it constant, if not how often does it occur and how long does it last? Is there anything that alleviates or aggravates the symptom? It may help to write these down before your doctor's visit.
  • Write down questions you want answered during your visit. Do not be afraid to bring them up, even if your doctor does not bring them up.
  • Bring a list of all medications, including any over the counter and herbal supplements you may be taking.
  • Bring copies of recent test results or treatment plans you may have from other doctor's you may be seeing.
  • A Personal Health Record (PHR) can help you to keep track of all this information. For information on creating a Personal Health Record click here.

Take an active role in every visit.

  • Listen, pay attention and ask questions, especially if you don't understand something. If you don't understand a medical term, ask them to explain it to you. Don't just ask the doctor what you should do. Ask why so your doctor can help you better understand your care.
  • Write down the diagnosis, the treatment plan and follow-up visits.
  • Be honest with your doctor about what you do and don't plan to do.
  • Ask about options or alternatives. What are the pros and cons of each treatment option? Talk with your doctor to determine which choice is best for you.
  • Ask someone to come with you to your appointment if you need help.

Learn all you can about your health problem - to get the best health care you need information whether it comes form your doctor, the library or the internet.

  • Start by asking your doctor for information about your problem. There may be information you can take home, your doctor can guide you to trusted sources of information and can connect you with other resources in his or her office or in the community.
  • If you use the internet to find health information as good place to start is Agency for Healthcare Research and Quality (AHRQ) or the Centers for Disease Control and Prevention (CDC).
  • If you have any concerns or questions about the information you find, discuss them with your doctor.

What are some indicators of a quality doctor?

They're willing to talk, they're not afraid of questions, they welcome second opinions, they're not afraid if you'd like to bring somebody else with you to the visit, they use an electronic medical record or have a system in place to remind you when you need preventive care and they try to connect you with a counseling service or coach or somebody in their office to help you understand your medications and your care management plan.

[i] Guide to Health Care Quality: How to Know it When You See It . Rockville, MD: Agency for Healthcare Research and Quality, 2005. (No authors given.)

[ii] Committee on Quality of Health Care in America , Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century . Washington : National Academies Press, 2001.

 

More on partnering with your doctor on the web:

 

Quick Tips - When Talking With Your Doctor

Help Your Doctor Help You

 

 

 

Wednesday, 22 October 2014 13:41

MHC - More About Quality Health Care

 

 More About Quality Health Care

 

In every community, both good and bad care is being provided in hospitals and doctor's offices. There are too many mistakes, too much miscommunication and too much inequity in our health care system.

Quality care is care that works – based on the best medical research about what has made you ill and what will make you better.

You can't take good quality care for granted.

Most Americans believe that the health care they receive is the best that medicine and science can provide. While we have some of the brightest, best trained, and most committed health care professionals in the world, we know that patients aren't getting the best care in the world. We spend more in total and more per capita on health care than any other country in the world. But the U.S. ranks 10 th in life expectancy among major industrialized nations and 27th in infant mortality.[i]

A 2004 study of 12 U.S. communities found that just over half (54.9 percent) of people were receiving the care they needed. As many as 91,000 Americans die each year because they don't receive the right evidence-based care for such chronic conditions as high blood pressure, diabetes and heart disease. [ii]

Fortunately, quality can be measured and it can be improved. Quality health care happens when you take an active role in your own care.

But how do you know whether the care you get is good quality care?

Quality health care is about getting

  • The right care - care that works—you should be given the type of care that medical research has shown to work best for your condition.
  • At the right time - care when you need it - your care should be timely. You should be given as much care as you need, but no unnecessary care.
  • For the right reason - your care should be given by health professionals who are skilled and knowledgeable. They should be respectful, communicate clearly and involve you in decisions about your care.

Poor-quality care comes in three forms: misuse, overuse, and underuse.

We give people care they do not need, we fail to give people care that we know works, and we make mistakes that hurt or kill people.

MISUSE: We make errors throughout the health care system. Some errors are human, but systems within hospitals, doctors' offices, and elsewhere can be designed to greatly reduce the risk of error.

 

  • Between 44,000 and 98,000 people die annually from preventable errors—more than from motor-vehicle accidents, breast cancer or AIDS. [iii]
  • Health care-associated infections in hospitals account for an estimated 1.7 million infections and 99,000 associated deaths each year. [iv]
  • Health care providers make more than 1.5 million medication errors each year, causing an estimated 7,000 deaths annually. [v]
  • Medication errors for hospitalized patients cost roughly $2 billion annually. [vi]
  • We tolerate margins of error in health care that are orders of magnitude higher than in other sectors of the economy. Most processes within health care experience 6,000 to 300,000 defects per million opportunities. This compares to error rates of 230 or fewer per million opportunities for world-class manufacturers and fewer than five errors in every million financial-service transactions. [vii]

 

OVERUSE: Americans get a lot of health care that we don't know doesn't help them. We often treat people without medical justification—for example, giving antibiotics for simple infections—or fail to follow equally effective options that cost less or cause fewer side effects. No one likes the idea of being denied health care that is necessary and life-saving. But by the same token, we should not want health care that costs far too much without generating any results.

  • Antibiotics are prescribed inappropriately for children's ear infections 13 million times a year—802 times out of every 1,000 doctor visits—despite the finding that more than 80 percent of infections get better within three days without antibiotics. [viii]
  • From 1993 to 2003, spending for lumbar fusion (a type of back surgery) rose 500 percent—from $75 million to $482 million—despite a lack of evidence supporting the effectiveness of back surgeries. [ix]  
  • As many as 78 Medicare patients per 1,000 are hospitalized for conditions like poorly controlled diabetes or worsening heart failure that could have been managed on an outpatient basis. [x]  
  • Some regions of the country use vastly more resources to treat patients with similar illnesses without achieving better outcomes. A whopping 30 percent of health care spending—nearly $700 billion a year—is for services that may not improve people's health. [xi]  

UNDERUSE: We do not give people the care they should get. We neglect to give them medically necessary care or to follow proven health care practices—such as giving beta-blocking drugs to people who have heart attacks.

 

What can YOU do to help make sure you are getting good quality care?

Once you understand that quality of health care does vary, it's clear you can't take good quality for granted. There is a lot you can do to improve the quality of care you and your loved ones receive. Quality health care happens when you take an active role in your own care. You will need to be actively involved in finding and using information that tells about health care quality.

  • For many people getting peace of mind begins with their relationship with their doctor. The key is finding the right doctor—one who values relationships based on openness and trust, and who provides high-quality care. For more information on How to Find the Right Doctor click here.
  • For people in good health, good care means care that balances prevention and treating illnesses.
  • For people with chronic conditions, good care means understanding what treatment is proven to work for what condition, and making sure that you're getting that level of care.
  • For people with loved ones who get sick or hurt, good care means knowing where to go to get the best care, without a lot of delays, hassle or misinformation.
  • For people who give care, quality care means that you are able to do your job and help people and systems are designed to help you do that. For all people who receive health care, we all need to learn and act on the differences between good and bad care, just like we choose where we live based on how good the schools are and how safe our neighborhoods are.

[i] OECD Health Data 2008. France: Organization for Economic Co-operation and Development and IRDES (Institute for research and information in health economics), 2008. (No authors given.)

[ii] The Essential Guide to Health Care Quality. Washington: National Committee for Quality Assurance, 2007. (No authors given.)

[iii] Kohn LT, Corrigan JM, Donaldson, MS (eds). To Err Is Human: Building a Safer Health Care System. Washington: National Academies Press, 2000.

[iv] Klevens RM, Edwards JR, Richards CL, Jr., et al. "Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002." Public Health Reports, 122: 160-166, 2002

[v] Aspden P, Wolcott J, Bootman JL, et al. (eds). Preventing Medication Errors: Quality Chasm Series. Washington: National Academies Press, 2007.

[vi] Kohn LT, Corrigan JM, Donaldson, MS (eds). To Err Is Human: Building a Safer Health Care System. Washington: National Academies Press, 2000.

[vii] Kohn LT, Corrigan JM, Donaldson, MS (eds). To Err Is Human: Building a Safer Health Care System. Washington: National Academies Press, 2000.

[viii] Subcommittee on Management of Acute Otitis Media. "Diagnosis and Management of Acute Otitis Media." Pediatrics, 113(5): 1451-1465, 2004.

[ix] Weinstein JN, Lurie JD, Olson PR, et al. "United States trends and regional variations in lumbar spine surgery: 1992-2003." Spine, 31(23): 2707-2714, 2006.

[x] Fisher ES, Goodman DC, Chandra A. Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project. Princeton, NJ: Robert Wood Johnson Foundation, 2008. [xi] Orszag P. Increasing the Value of Federal Spending on Health Care. Washington: Congressional Budget Office, 2008.

 

More about quality care on the web:

 

Agency for Healthcare Research and Quality - Patients & Consumers

My Health Counts! Finding Dr. Right