U.S. Efforts to Boost Medical Care for Poor Effective

There was no improvement in "intermediate outcomes," however -- clinical markers such as the need for urgent care or hospitalization for asthma, or the control of blood pressure for hypertension.

"These things can be effective, but sometimes they don't work and the reasons they don't work are not always clear," Landon said.

While praising the study, Dr. Rodney Hayward, author of an accompanying editorial, pointed to bigger problems with evaluating quality of health care in this country.

"The study shows us how hard it is to achieve real high levels on some of these quality measures," said Hayward, who is director of health services research and development at the VA Ann Arbor Healthcare System and a professor of medicine and public health at the University of Michigan. "We have to better understand some of the reasons we're not at the level we wish to be."

While some point to problems with health-care quality (for example, the doctor is responsible for patients not taking their blood pressure medication), others point to consumer/patient issues (they're ultimately responsible for taking their medication correctly).

"Some measures are not necessarily a perfect reflection of quality. They're not even close to perfect," Hayward said. "If we adjust payments [to reflect those measures], we can really do some unfair things that might harm the patients that need the most attention."

But the current processes for determining issues such as quality measures are highly political, Hayward said. "The science and the evidence often get left out," he said. "My personal belief is that this will not improve until we have independent groups that evaluate and give information based on the best medical evidence and what is best for the public. Right now, we don't have any such process."

More information

There's more on the Health Disparities Collaboratives at the HRSA.

SOURCES: Bruce Landon M.D., M.B.A., associate professor, health-care policy and medicine, Harvard Medical School, Boston; Rodney Hayward, M.D., director, health services research and development, VA Ann Arbor Healthcare System, and professor, medicine and public health, University of Michigan, Ann Arbor; March 1, 2007,New England Journal of Medicine