Quality of diagnoses and cost of managing anemia in four countries.

An earlier study of non-hospitalized Swedish patients suggested frequent overprescribing of iron tablets and frequently uncertain diagnoses of iron deficiency. For this reason, a record audit was performed of 202 patients hospitalized because of iron deficiency anaemia or pernicious anemia in an English, a French, three Swedish, and a US teaching hospitals. Results are difficult to interpret because of the limited extent of this study and because differences between hospitals are as great as those between countries. Nevertheless, the Swedish hospital seemed to have 37% longer duration of stays (p less than 0.05), it spent only 16% of the total hospitalization cost for diagnostic studies as compared to 22-35% for the other hospitals, and it had numerically, but not significantly increased percentages both of uncertain diagnoses and of unidentified causes of the iron deficiency. For comparable time periods the hospitals with the longest length of stay also had the highest percentage of uncertain diagnoses (p less than 0.001). After the local publication of the first reports in 1978-1981, an improvement in the percentage of uncertain diagnoses was found in the Swedish hospital, which suggests that quality evaluation can lead to quality assurance.