Volume 197 - Issue 10
CareTrack: assessing the appropriateness of health care delivery in Australia
Author: Paresh Dawda
Med J Aust 2012; 197 (10): 548-549. || doi: 10.5694/mja12.11149
Published online: 19 November 2012
Published online: 19 November 2012
To the Editor: The CareTrack study1 has produced considerable debate that has mostly focused on its aggregated findings about compliance with appropriate health care delivery. There needs to be much wider discussion, not about the aggregate figure, but about the variation, such as the 39 health care providers for whom compliance varied between 32% and 86%. Such unwarranted variation in health care has been identified elsewhere ...
To the Editor: The CareTrack study1 has produced considerable debate that has mostly focused on its aggregated findings about compliance with appropriate health care delivery. There needs to be much wider discussion, not about the aggregate figure, but about the variation, such as the 39 health care providers for whom compliance varied between 32% and 86%. Such unwarranted variation in health care has been identified elsewhere through proactive initiatives.2,3
Most clinicians do the very best they can for their patients, but that “very best” is hugely variable. Initiatives to reduce this variation require multiple interventions at multiple levels, including by political, regulatory and professional bodies, and at provider level.4 We at the frontline have to take accountability for the care we deliver. We have to look at clinical outcomes data for patients much more than the 24% of the time we currently do.5
A strategy of guidelines, education and reliance on hard work and vigilance cannot on its own deliver higher levels of compliance, without deliberately designed processes of care that are reliable,6 and a culture of excellence. This requires leadership, an understanding of the science of improvement, and a commitment to measuring for quality improvement, with a drive to strive for excellence. We may be doing our very best, and the care we deliver may be good, but good is the enemy of great. We can do even better for our patients, and if we do not take the lead in the journey towards greatness, then external drivers and regulation will force us to.
Competing interests
I have acted as a consultant, written commissioned articles and presented as a paid speaker internationally in primary care quality improvement.
References
- Runciman WB, Hunt TD, Hannaford NA, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust 2012; 197: 100-105. 0_CHDGFGBC
- The Dartmouth Atlas Working Group. The Dartmouth Atlas of Health Care. Quality/effective care. http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=25 (accessed Jul 2012).
- National Health Service Right Care. NHS Atlas. http://www.rightcare.nhs.uk/index.php/nhs-atlas/ (accessed Jul 2012).
- Dawda P, Jenkins R, Varnam R. Quality improvement in general practice [discussion paper]. London: The King’s Fund, 2010. http://www.kingsfund.org.uk/sites/files/kf/field/field_document/quality-improvement-gp-inquiry-discussion-paper-mar11.pdf (accessed Jul 2012).
- Schoen C, Osborn R, Michelle MM, et al. A survey of primary care physicians in 11 countries, 2009: perspectives on care, costs, and experiences. Health Aff (Millwood) 2009; 28 (6): w1171-w1183. http://www.commonwealthfund.org/Publications/In-the-Literature/2009/Nov/A-Survey-of-Primary-Care-Physicians.aspx (accessed Jul 2012).
- Resar RK. Making noncatastrophic health care processes reliable: learning to walk before running in creating high-reliability organizations. Health Serv Res 2006; 41 (4 Pt 2): 1677-1689. 0_CHDGIJCH