While providers are willing to give high marks for at least some of the steps taken to address the Institute of Medicine’s 1999 report on the high number of medical errors in this country, consumers surveyed as part of the five-year anniversary of the report don’t believe the nation’s quality of care has improved.
The consumer survey, conducted by the Kaiser Family Foundation, U.S. Agency for Healthcare Research and Quality, and Harvard School of Public Health, found that 40% of respondents believe the quality of health care has gotten worse in the past five years, while 17% say it has gotten better and 38% think it has stayed the same.
Nearly half of U.S. residents (48%) said they are concerned about the safety of the medical care that they and their families receive, and 55% said they are dissatisfied with the quality of U.S. health care, up from 44% who gave that opinion in a survey conducted four years ago.
The latest survey found that people with chronic health conditions are considerably more likely than other consumers to express concerns about their quality of care and report having personal experiences with medical errors. "This survey shows that the challenge is not just to improve patient safety, but to convince the public that real progress is being made," said Kaiser Family Foundation president Drew Altman.
After being read a common definition of a medical error, 34% of those interviewed said that they or a family member had experienced a medical error at some point in their lives, including 21% of all Americans who said that a medical error caused serious health consequences such as death (8%), long-term disability (11%), or severe pain (16%).
Some 14% of those who said the error caused serious health consequences (3% of all Americans) said that they or their family filed a malpractice lawsuit as a result of the error. Of those who were involved in a medical error, 28% (9% of all Americans) said the doctor or other health professional involved told them about the medical error. Half of all people with chronic conditions reported they have experienced a medical error in their own care or the care of a family member, far more than those without chronic illnesses (30%). Some 92% of Americans said that reporting of serious medical errors should be required, and 63% want the information released publicly. Almost nine in 10 (88%) said doctors should be required to tell a patient if a preventable medical error resulted in serious harm in the patient’s own care.
Consumers’ views on errors
Consumers are most likely to cite workload, inadequate staffing, and poor communication among health care providers as causes of medical errors, with 74% saying workload, stress, or fatigue of health professionals is a very important cause of medical errors. Nearly as many said that doctors not having enough time with patients (70%), too few nurses in hospitals (69%), and health professionals not working together or not communicating as a team (68%) are very important causes of medical errors.
When asked about a variety of potential solutions, 79% said that giving doctors more time to spend with patients would be "very effective" in reducing preventable medical errors, while nearly as many said that requiring hospitals to develop systems to avoid medical errors (72%) and better training of health professionals (72%) would be "very effective." Slightly more than half (51%) said that more use of computerized medical records instead of paper records for ordering drugs and medical tests would be very effective.
"Many steps have been taken to improve patient safety, and the greater use of health information technology is one of the most promising developments in this area," said Agency for Healthcare Research and Quality director Carolyn Clancy. "However, these are largely system-related improvements that aren’t always apparent, even though consumers may recognize their importance. Our challenge is to show the connection between these kinds of changes and improving the care patients receive, while at the same time expanding and accelerating these efforts," she added.
The survey found that 35% of people said they have seen information comparing the quality of health plans, hospitals, or doctors in the past year, up from 27% in 2000. Some 19% of all Americans said they have used comparative quality information about health plans, hospitals, or other providers to make decisions about their care, up from 12% in 2000. More specifically, 14% of consumers said they have used quality information to choose health plans, 8% to choose hospitals, and 6% to choose doctors.
Consumers generally said that data about medical errors, numbers of malpractice cases, and professional experience are most likely to be useful at assessing quality of care. For example, 70% said that information about medical errors or mistakes would tell them "a lot" about a hospital’s quality of care.
Consumers are nearly as likely to say that information on how many times a hospital has performed a particular test or surgery (65%) and information on how many patients die after having surgery (57%) tells them "a lot." Fewer, but still approximately half, said that how patients rate a hospital’s quality of care (52%) or the number of patients who don’t get standard recommended treatments (47%) tells them "a lot" about quality.
Steps to reduce errors
The survey also found that a significant number of Americans said they have taken precautions to reduce the risk of experiencing a medical error when seeking treatment, including:
- checking medication that a pharmacist gave them with the prescription their doctor wrote (69%) and bringing a list of all medications taken to a doctor’s appointment (48%);
- calling to check on results of a medical test (69%);
- talking to a surgeon about details of a proposed surgery, such as exactly what the surgeon will do, how long it will take, and the recovery process (66%);
- taking a friend or relative with them to ask questions and help them understand what their doctor was telling them (43%);
- consulting their doctor about the hospital they use (37%).
The Agency for Healthcare Research and Quality says it recommends use of such precautions to enable patients and their families to reduce their risk of experiencing medical errors.
University of California at San Francisco physician Robert Wachter, who wrote an analysis of progress made in the five years since the IOM report, says the difference in perceptions of progress between providers and patients is not unexpected. "Patients’ perceptions are related to what they can see," Mr. Wachter tells State Health Watch. "The system still appears chaotic to patients. It doesn’t appear well thought out, and that often is the case."
Patients also deal with recollections rather than current experience, according to Mr. Wachter. And he says that, in some ways, the IOM report engendered a higher level of public distrust, even as it helped galvanize energy and resources to be used to address the problem. "We can’t fix the problem of medical errors unless people appropriately understand the need for it to be fixed," he says.
While some have called for a massive public relations effort to convince people they are safer, Mr. Wachter tells us he’s not sure that’s the most important thing to do at this point, especially since he is convinced that patients are not yet safe enough and more work needs to be done.
(Download the survey report from www.kff.org.)