Five Years After IOM Report On Medical Errors, Nearly Half Of All Consumers Worry About The Safety Of Their Health Care
Embargoed for release until:Wednesday, Nov. 17, 2004, 9:30 a.m. ET
For further information contact:Craig Palosky, KFF, (202) 347-5270Chris Peacock, KFF, (650) 854-9400Howard Holland, AHRQ, (301) 427-1857
FIVE YEARS AFTER IOM REPORT ON MEDICAL ERRORS, NEARLY HALF OF ALL CONSUMERS WORRY ABOUT THE SAFETY OF THEIR HEALTH CARE
One in Three People Say They Or A Family Member Have Experienced A Medical Error; One in Five Say It Was “Serious”
People with Chronic Conditions Most Likely to Report Problems
Of Those Reporting Medical Errors with Serious Consequences, One in Seven Report Filing Malpractice Lawsuits
Washington, D.C. – Five years after a groundbreaking Institute of Medicine report focused attention on medical errors in hospitals, Americans say that they do not believe that the nation’s quality of care has improved. Four in 10 (40%) people say the quality of health care has gotten worse in the past five years, while one in six (17%) say the quality of care has gotten better and nearly four in 10 (38%) say it has stayed the same, according to a new survey by the Henry J. Kaiser Family Foundation, the U.S. Agency for Healthcare Research and Quality (AHRQ) and the Harvard School of Public Health.
The survey of 2,012 adults, which was conducted by telephone from July 7 to Sept. 5, 2004, also finds that nearly half (48%) of U.S. residents say they are concerned about the safety of the medical care that they and their families receive, and more than half (55%) say they are dissatisfied with the quality of health care in this country – up from 44% who reported the same in a survey conducted four years ago. The survey finds 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.
These perceptions exist despite the efforts by hospitals, doctors, health plans and purchasers to reduce medical errors and improve the quality of care in the wake of the 1999 Institute of Medicine report, “To Err is Human: Building a Safer Health System.” The report concluded that hospital-based medical errors were the eighth leading cause of death in the United States and that the primary cause was problems with the health system itself rather than the performance of individual doctors, nurses, and other providers.
“This survey shows that the challenge is not just to improve patient safety, but to convince the public that real progress is being made,” Kaiser Family Foundation President Drew Altman said.
Personal experiences with medical errors
After being read a common definition of a medical error, about one in three people (34%) say that they or a family member had experienced a medical error at some point in their life. This includes 21% of all Americans who say that a medical error caused “serious health consequences” such as death (8%), long-term disability (11%) or severe pain (16%). About one in seven of those who said the error caused serious health consequences (14%, or 3% of all Americans) say 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) say the doctor or other health professional involved told them about the medical error.
The survey found that half (50%) of all people with chronic conditions say that they have experienced a medical error in their own care or that of a family member – far more than those without chronic illnesses (30%).
Consumer views of policy solution
More than nine in 10 Americans (92%) say that reporting of serious medical errors should be required, and most (63%) want this information released publicly. Almost nine in 10 (88%) say that physicians should be required to tell a patient if a preventable medical error resulted in serious harm in the patient’s own care.
Consumers are most likely to cite workload, inadequate staffing and poor communication among healthcare providers as causes of medical errors – with about three in four (74%) saying workload, stress or fatigue of health professionals is a very important cause of medical errors. Nearly as many say 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% say giving doctors more time to spend with patients would be “very effective” in reducing preventable medical errors, while nearly as many say that requiring hospitals to develop systems to avoid medical errors (72%) and better training of health professionals (also 72%) would be “very effective.” Just over half (51%) say 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 AHRQ director Carolyn M. Clancy, M.D. “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 those efforts.
Quality information that consumers want
The survey finds that more than one out of three (35%) people say they have seen information comparing the quality of health plans, hospitals or doctors in the past year – a higher share than in 2000 (27%).
Almost one in five (19%) of all Americans say 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 say they have used quality information to choose health plans, 8% to choose hospitals and 6% to choose doctors.
Consumers generally say that data about medical errors, numbers of malpractice cases and professional experience is most likely to be useful at assessing quality of care. For example, seven in 10 (70%) say that information about medical errors or mistakes would tell them “a lot” about the quality of care in a hospital. 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 about half, say that how patients rate the quality of care of a hospital (52%) or the number of patients who do not get standard recommended treatments (47%) tells them “a lot” about quality.
“The public isn’t getting the quality information it wants,” said Robert J. Blendon, Sc.D. Professor of Health Policy at the Harvard School of Public Health. “If the information they wanted the most were to become available, people might use it more often in the choices they make about their own health care.”
When looking for information on quality of care, people are most likely to say they would ask their doctor, nurse or other health professional (65% said they were very likely to do this), or ask their friends and family (65%). Fewer would go online (37%), contact someone at their health plan (36%), contact a state agency (18%) or refer to a section of a newspaper or magazine (16%). About one-third (36%) of people age 65 and older say they would be very likely to contact the Medicare program.
People also are more likely to chose a hospital by what is familiar (61%) rather than by a high rating (33%), but are split as to what is more important when choosing a surgeon – whether a surgeon has treated a friend or family member without any problems (48%) or received high ratings (46%). They are also divided as to which is more important when choosing a health plan – whether it is recommended by a friend (45%) or if it is rated highly by experts (49%).
Steps To Promote Safety
The survey also suggests significant numbers of Americans say they have taken precautions to reduce the risks of experiencing a medical error when seeking treatment. For example, the new survey finds that:
- Almost seven in 10 (69%) say they have checked the medication that a pharmacist gave them with the prescription that their doctor wrote and nearly half (48%) say they have brought a list of all of their medications, including non-prescription drugs, to a medical appointment;
- Almost seven in 10 (69%) say they have called to check on the results of medical tests;
- About two in three (66%) say they have talked to a surgeon about the details of surgery, such as exactly what the surgeon will do, how long it will take, and the recovery process;
- More than four in 10 people (43%) say they have brought a friend or relative with them to ask questions and help them understand what the doctor was telling them;
- More than one in three (37%) say they have consulted their doctor about the hospital that they use.
AHRQ recommends these types of precautions to enable patients and their families to reduce their risk of experiencing medical errors. AHRQ worked with the Centers for Medicare & Medicaid Services and other federal partners to develop a resource called, Five Steps to Safer Health Care that includes these precautions and others. More information about Five Steps to Safer Health Care” is available at http://www.ahrq.gov/consumer/5steps.htm .
In addition to the new survey, Dr. Altman, Dr. Clancy and Dr. Blendon also collaborated on a perspectives column published in the Nov. 11 New England Journal of Medicine. The column, “Improving Patient Safety – Five Years After the IOM Report,” examines patient safety efforts and public opinion trends.
Methodology
The National Survey on Consumers’ Experiences With Patient Safety and Quality Information is a joint project of the Kaiser Family Foundation, the Agency for Healthcare Research and Quality, and the Harvard School of Public Health. Representatives of the organizations worked together to develop the survey questionnaire and analyze the results. The survey was conducted by telephone from July 7 to September 5, 2004 among a randomly selected nationally representative sample of 2,012 adults 18 years or older. Interviews were conducted in English and Spanish by Princeton Survey Research Associates. The margin of sampling error is +/-2 percentage points overall. The margin of sampling error will be higher for results based on subsets of respondents. Sampling error is only one of many potential sources of error in this or any public opinion poll. Before answering questions on medical errors, respondents were all read a common definition of medical errors. They were told, “Sometimes when people are ill and receive medical care, mistakes are made that result in serious harm, such as death, disability, or additional or prolonged treatment. These are called medical errors. Some of these errors are preventable, while others may not be.” Trend data is from the Kaiser Family Foundation/Agency for Healthcare Research and Quality Americans as Health Care Consumers: The Role of Quality Information (1996), The Kaiser Family Foundation/Agency for Healthcare Research and Quality National Survey on Americans as Health Care Consumers: An Update on the Role of Quality Information (2000), and the Harvard School of Public Health/Kaiser Family Foundation Medical Errors: Practicing Physician and Public Views (2002).
A webcast of this event will be provided by kaisernetwork.org, a free service of the Kaiser Family Foundation. The webcast, complete survey findings and related resources are available at http://www.kff.org/kaiserpolls/pomr111704pkg.cfm .
The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.
The Agency for Healthcare Research and Quality is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services.
Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 800-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights.
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