The CareTrack Australia study[i] – a large-scale, systems-level examination of patient care in Australia – was designed to determine the percentage of healthcare encounters at which a representative sample of adult Australians received “appropriate care” (care in line with evidence- or consensus-based guidelines) following the RAND-UCLA study in the USA ten years earlier. Participants in our sample received appropriate care in 57% of 35,573 eligible encounters compared with the US at 55%. We found high compliance for some conditions such as the management of coronary artery disease (90%) and dyspepsia (78%), and poor compliance for the use of recommended risk assessment tools (1%) and inadequate responses to severe or deteriorating conditions (between 5-40%). At health care provider level, compliance ranged from 32-84%. We cannot rule out that it is a current property of modern health systems that only half the care delivered is appropriate. Although we do not know for certain, we can surmise that the results apply in other OECD settings including across Europe (and therefore in the NHS). We will discuss the study, consider its implications, and propose some initial steps for addressing this situation.[ii]
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