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    Money Can't Buy U.S. Health


    Whatever the reasons for the low U.S. ranking, Starfield recommends further research into "the nature and operation of the [U.S.] health care system," including looking at the relationship between treatment-caused and physician-caused complications.

    So what's the prescription for an ailing health care system?

    "The solution to our medical problems is not a quick fix," says Janet Corrigan, PhD, chair of the board of health care services at the Institute of Medicine in Washington, D.C., and one of the editors of the "To Err is Human" report. "It will require fundamental reorganization of health care services. We need to make the best use of medical technology, we need better ways to translate the medical knowledge base into best practices, and we need better systems at the delivery level than we currently have. The need for information is crucial."

    "The Institute of Medicine is talking about what needs to be done. The VA is doing it," says John Fuessner, MD, chief of the research and development office of the Veterans Affairs Administration in Washington, D.C. He says the VA's Quality Enhancement Research Initiative (QUERI) program is a step in the right direction that he hopes will "systematize care, improve care and outcomes, and provide new information when it becomes available to support these objectives."

    QUERI has been ongoing for several years now, according to Fuessner. "The VA is fortunate to have in place very powerful information systems to allow us to track data of all kinds," he tells WebMD. "These are not available to academic settings or the private sector, which complicates implementation."

    Corrigan agrees, saying, "It's quite surprising that most of the health care system continues to operate recording the vast majority of information on paper, with no integration or dissemination of that information for the most part. One could make a strong case for developing national standards for how information is recorded."


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