Shrinking The Chasm
The barriers to improvement described above suggest that medical care quality chasm will always be with us. Nonetheless, the chasm does not have to be as large as it is now. Greater use of information technology can help; if patient's medical history and all available test and medication data were available online at the time physician was making diagnostic or treatment decision, quality would surely improve. Greater use of computerized decision support systems also would improve quality.
Health services research can also help. Most of the evidence of inefficiency I cited came from health services research. When the scope of the problem is not known, better performance is improbable. In some cases, simply disseminating the findings can improve matters through the goodwill, altruism, or professionalism of health care providers. And research on financial incentives could play an important role. Physicians want to practice good medicine. But there are costs to keeping up, and in many cases the rewards for using the best technique are weak or even negative. The design of better incentives thus should be high priority.
The author thanks the Alfred P. Sloan Foundation and the Hans Sigrist Stiftung for support and David Cutler, Victor Fuchs, Tom McGuire, Don Metz, and two referees for comments on a preliminary draft.
Health Affairs. 2002;21(4) © 2002 Project HOPE
Cite this: Why Is There a Quality Chasm? - Medscape - Jul 01, 2002.