1. Quality of Health Care in the U.S. 6712 patients from 12 metropolitan areas Medical record review (2 yrs) + interview 30 acute/chronic conditions, preventive care 439 indicators for screening, dx, rx & f/u care Results: patients received ~55% recommended care Conclusion: The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. McGlynn, NEJM 2003;348:2635-45

2. Systematic Review: The Relationship between Clinical Experience and Quality of Health Care* Systematic review of 62 reports 4 categories of reports: Medical knowledge Adherence to standards of care for diagnosis, screening, or prevention Adherence to standards of care for therapy Health outcomes 6 result categories: consistently negative, partially negative, no effect, mixed effect, partially positive, consistently positive *Choudhry, Ann Intern Med 2005;142:260-273.

3. Overall Results for 62 Reports

4. Results for Medical Knowledge All 12 showed consistently negative results Knowledge measured: General knowledge (4) HIV care (3) Hypertension, MI, emergency contraception, lung cancer and blood product transfusion (1 each)

5. Adherence to Standards for Screening, Diagnosis & Preventive Health Care

6. Adherence to Standards for Appropriate Use of Therapy

7. Relationship to Health Outcomes