"I think this drives home the message that for a variety of very well-measured attributes of medical care, there are substantial differences across states," says Fisher, who also is co-director of the VA Outcomes Group, a research group based at the Veterans Affairs Hospital in White River Junction, Vt., "Even the best states could do much better. There is lots of room for improvement."
The challenge, Fisher cautions, will be to use the information to improve overall systems of care, rather than focusing on specific measures on which states fared poorly. "There will be a temptation to look at these results in the same way that physicians look at report cards," he says. "We need take what we learn from these measures of variation and modify the systems to achieve the results we know we can achieve."
But some medical societies in states that did not score well suggest that the study does not necessarily tell the entire story. Leroy Sprang, MD, president of the Illinois State Medical Society, acknowledged there are areas of care that can be improved, but said the report's focus on performance measures may not indicate how the patients actually fared in treatment.
Jencks says that doctors and others who react defensively to the report, and patients who react with fright, risk missing the potential inherent in its findings.
"The point is that there is an opportunity to improve care, and the opportunity is best realized through systems change," Jencks says. "These figures are not about what has gone wrong. We have a system that is getting better."