Reviewing data from the Centers for Medicare and Medicaid Services on 10 indicators for quality of care at 3,558 hospitals in the first half of 2004, researchers at Harvard School of Public Health found that simple, universally accepted treatments were not provided for

'Is This the Best We Can Do?'

Treatment can be as simple as giving a heart attack patient an aspirin, something only 92% of hospitals do for all appropriate patients, says Ashish Jha of the Harvard School of Public Health and lead author of one of the papers.

But despite authoritative, universal agreement that those measures should happen quickly and be given to all patients, a surprising number didn't receive them.

"Is this the best that we can do for three conditions where the evidence is so compelling?" says Kenneth Kizer, president and CEO of the National Quality Forum, a non-profit developing national strategy for health care quality. The group was not involved in the studies.

The Jha paper used newly available data from the Hospital Quality Alliance, an association of medical schools, hospitals and government agencies.

Compliance Spotty

The research echoed data presented in the second paper by the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, the organization that accredits US hospitals.

The JCAHO paper, which examined data from 3,087 hospitals, found that from 2002 to 2004, hospitals ranged from 3% to 33% improvement; poorly performing hospitals improved the most. But compliance was still spotty.

JCAHO found a range: 91% of heart attack victims got beta-blockers, which slow the heart and lower blood pressure; only 55% of heart failure patients received necessary discharge instructions.

"In order to provide appropriate care, you've got to multi-task. You've got to do it all, and you've got to do it 100% of the time," says Jerod Loeb, executive vice president for research at JCAHO. "There are no excuses."

Green Elixir Needed?

The studies illustrate a problem in modern medicine: Though there's a growing list of scientifically supported protocols for specific conditions called "evidence-based medicine," physicians and hospitals don't always follow them.

Making the shift requires creating evidence-based guidelines, getting hospitals and doctors to accept they're the right thing to do, agreeing how to measure results and finding processes to make sure they happen, Loeb says.

Those processes probably will involve financial incentives, he says. "As much as we like to think of medicine as an altruistic profession, green seems to be the color of the (needed) elixir."