Commentary: Public Health and Health Care Quality Assurance—Strange Bedfellows?

Abstract

What is the role of governmental public health in ensuring the quality of medical care? With some notable exceptions, state and local public health departments have taken a passive role in medical care system quality assurance. Yet medical care can contribute much to improving the health of populations and at least some to reducing health disparities. The article in this issue of The Milbank Quarterly by Chamany and colleagues describes one public health agency's novel approach to the clinical management of adult diabetics: working with health care providers. The authors regard their work as filling a temporary gap, pointing out that most providers are not equipped to automatically remind patients to consult their doctor when laboratories report high glycosylated hemoglobin (A1C) levels. But clinical decision support systems’ broader use of electronic health records, which is now a federal priority, should, at least in theory, make it unnecessary for public health agencies to assume this role.