Accreditation will deal with globalization of care

The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, soon will offer international accreditation services. Since 1994 the agency has offered international consultation services through Joint Commission International (JCI), a partnership between JCAHO and its consulting subsidiary Quality Healthcare Resources. Renamed Joint Commission Resources (JCR), the entity is collaborating with the International Society for Quality in Health Care to develop a set of core international principles that can be used to guide the evaluation of culture-specific standards. The Joint Commission subsidiary will serve as the umbrella entity for international accreditation services and for domestic and international consulting services.

The 1999 endeavor comes as United States-based organizations begin to expand their ownership of entities abroad, bringing with them expectations prevalent in this country. K. Tina Donahue, president of JCR, said in a statement, "Accreditation can help international health care organizations position themselves to deal with emerging issues surrounding the privatization and globalization of health care." For more information on JCR, contact Jim Janeski, executive director of International Services. Telephone: (630) 268-7424. E-mail:

MDs miss vital info during patient visits

Primary care physicians perform poorly when taking medical histories and performing preventive screening, according to a recently published study in the American Journal of Medicine. In fact, researchers found that primary care physicians often missed important information related to a patient’s symptoms and medical history.

Researchers analyzed the history-taking and preventive-screening skills of 134 primary care physicians from five Northwestern states. The researchers presented physicians with standardized patient cases, individuals who were trained to present a certain medical profile to physicians. Researchers then scored physicians on the number of essential history and preventive screening items addressed during each patient visit.

Roughly 75% of physicians asked questions that described presenting symptoms, and 83% of internists and 71% of family practitioners asked about medications and allergies to medications. Other findings include:

• Only 50% of internists and family practitioners asked pertinent history questions related to the patient’s current complaint.

• Only 74% of patients were asked about tobacco use.

• Only 60% of patients were asked about alcohol use.

• Only 41% of patients were asked about use of recreational drugs.

• Only 50% of all physicians reviewed medical systems or past medical history.

For example, 56% of physicians in the study group failed to ask a 60-year-old man with fatigue and weight loss related to undiagnosed lymphoma whether he had night sweats, which would increase suspicion of lymphoma.

In addition, researchers found that very few physicians asked about patients’ sexual histories or risk factors for AIDS and other sexually transmitted diseases. Researchers concluded that physicians might improve their performance if they used a medical intake questionnaire to enhance medical history taking.

(See: Ramsey PG, Curtis JR, Paauw DS, et al. History taking and preventive medicine skills among primary care physicians: An assessment using standardized patients. Am J Med 1998; 104:152-158.)