Self-Fulfilling Prophecy?
Karen Davis, et. al. report for the Commonwealth Fund on patient surveys in 2004 and 2005 on the IOM’s six criteria for healthcare quality. Surveys were done in 5 countries, and showed that US patients thought highly of US healthcare with respect to “effectiveness” (a.k.a. the technical aspect of care) but ranked our system poorly (usually last) in the other dimensions. This is not unexpected when you consider what the average patient has been hearing about the US healthcare system in the last few years: namely that we make lots of errors, screw things up in other ways whenever we can, and occasionally kill people.
Well, we do have problems. But I’m not convinced we are any worse than any other country you could name. Remember now, these are patient opinions (and recollections), so they are likely to be influenced by the public face of US healthcare. We need objective measures of the facts, rather than patient opinions. One paper cited previously here measured medication errors in Canadian hospitals and found they were essentially identical to those in the US. The CMWF paper mentions lab errors. Folks in my office (State Department) evaluate laboratories in every country in the world, and we do use labs in some other countries, but on average, no one does it better.
They also mention poor access to care for low income patients. This, I think, is the wrong fruit. Our system is based on private health insurance (ignoring Medicare/Medicaid for now), and health insurance is linked to employment. You may bemoan the socio-economic system that fails to provide health insurance to low income Americans, but that is not the fault of the healthcare system. Write your Congressman. That’s a political problem. To be fair, you have to compare people with the same health insurance but different incomes. In that respect, I really don’t believe I get better healthcare than the man who empties my waste basket (and also has federal BC/BS insurance).
Comments
Bob, besides the IOM report in 1999, there is the 2003 Healthgrades study who population in the study was much bigger than the IOM. Healthgrades looked at all Medicare admissions in the United States (60% of admissions) over 3 years (200,2001,2002) and determined that the IOM reported had under-reported the number of deaths due to hospital medical errors. It stated that it was actually 197,000 which, they stated was equal to 390 jumbo jets crashing each year. Now those are numbers that should shake the "system" but didn't.
NCQA reported in 2003 that there were 57,000 lives lost in the ambulatory care setting due to the distance between what we know to do and what we acturally do. The two biggest contributors, at more than 25% each, were hypertension and diabetes. These are two disease entities that we know enough to get a good handle on outpatient therapy to control these diseases.
Finally, the IOM just released another confirmatory study ordered by Congress in 2003 which stated that nothing had changed.
One of the authors of the latest IOM study stated that only 7% of hospitals have incorporated computerized medication administration system. In one of these hospitals, the computer identified 74 different instances where the nurse was about to give a patient medication and scanned the patients barcoded wristband, only to find out that the patient was the wrong patinet. These would most likely have been 74 medication errors that we would not otherwise have identified.
I think the issue of patient safety and healthcare errors is worse than what we think it is because we only count the errors we know of. We can't count the errors we do not detect.
Whether or not we are worse than any other country is really not important, we have the capability, but not the will, to make the change. If a jumbo jet crashed every day, we would find it important to improve the safety of the airline industry but because deaths due to healthcare errors do not make the news every day, we do nothing.
We do wonderful things with technology and save lives in dramatic fashion. But we do not save thousands of lives because it not done in dramatic fashion.
Posted by: John Harrison, RN, MHSA | September 11, 2006 10:48 AM
It is also important to remember the role education plays in receiving healthcare; the man who "empties your trash" may have the same access to healthcare that you odo, but is he as imformed as you in knowing his options and knowing that he does need healthcare? The insurance companies are spending a lot of dollars these days on providing education to their members and a fact that cannot necessarily be overlooked when asking these kinds of questions.
John also has a great point in that we don't look at the errors not detected--are we even trying to find them? The dramatic, much in part thanks to the media, is a huge factor in healthcare.
We are certainly in for interesting times ahead.
Posted by: Nikki Barr | September 15, 2006 09:55 AM