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Netter’s Internal Medicine 2nd Edition PDF
Content
At the same time, Americans have lately become much
more conscious of practitioners’ imperfections, and they
are especially aware of the shortcomings of the system
that they must navigate to obtain care. The public now
knows that the health care system often falls short of its
potential; that medical care sometimes causes avoidable
harms; and that the system includes wide variations in
practice and cost without apparent differences in benefi t
to patients. Caregivers, and the organizations in which
they practice, are increasingly tasked to demonstrate that
their respective practices meet available standards and
avoid potential harms.
As doctors well know, we remain limited in our ability
to collect valid and reliable data and to appropriately
compare different types of practice behaviors and different
types of patients. Just as important, reimbursement models
are fundamentally misaligned from the goals of optimizing
performance and patient safety. Public and private pressures
to change practice are, for now, modest, and physicians
will face these demands while continuing to cope
with others that at times will seem more pressing—such as
billing regulations, staff shortages, and declining income.
Despite these additional pressures, scrutiny of physician
practice by the government, by payors and their customers
(employers), and by the public is here to stay.
Before the mid-1990s, payors, policy makers, and the
profession gave scant attention to the shortcomings of the
health care system. To be sure, the U.S. tort system has
long permitted compensation for individual victims of negligence.
For a plaintiff to be compensated, a defendant
must be judged as failing to meet a standard of care and
therefore blamed for “more likely than not” causing harm.
Medicine weathers periodic crises of rising insurance premiums,
and a few states have enacted reforms, but the U.S.
malpractice system remains fundamentally unchanged in
structure, and it has contributed little if anything to the
real evolution of the scrutiny of clinical practice.
The attention to the quality and safety of medical care
is the result of several other trends. From roughly the
1960s to the 1980s, what we now call health services
researchers gradually standardized the methods for evaluating
the structure of health care delivery models, the
processes of care delivery, and clinical outcomes. Advances
in information technology have gradually brought the
computing power to apply these methods for evaluating
care, processes, and outcomes. Federal support for the..