U.S. Residents Believe Quality of Health Care Worsening, Survey Shows
Four in 10 U.S. residents believe that the quality of health care in the United States has worsened in the past five years, despite widespread efforts by the health care industry to reduce medical errors following a 1999 Institute of Medicine report that attributed between 44,000 and 98,000 deaths annually to preventable mistakes made in U.S. hospitals, according to a report released Thursday by the Agency for Healthcare Research and Quality, Kaiser Family Foundation and the Harvard School of Public Health, the Scripps Howard/Detroit News reports (Bowman, Scripps Howard/Detroit News, 11/18).
For the report -- which has a margin of error of plus or minus two percentage points -- researchers surveyed 2,012 randomly selected adults across the United States by phone from July 7 to Sept. 5. Findings are summarized below.
- Forty percent of the public believes that the quality of care in the United States has worsened in the past five years, compared with 38% who believe it has stayed the same and 17% who believe it has improved (May Yee, Minneapolis Star Tribune, 11/17).
- About 55% of the public are dissatisfied with the quality of care, up from 44% four years ago (Bloomberg, 11/17).
- Forty-eight percent of the public are concerned about the safety of medical care that they and their families receive (Minneapolis Star Tribune, 11/18).
- Thirty-four percent of the public say that either they or a family member have experienced a medical error at some point.
- People with chronic conditions were more likely to express concern about their quality of care and to report having experienced a medical error themselves or by a family member, according to the report (Kaiser Family Foundation release, 11/17).
- 21% of U.S. residents say they experienced a medial error that caused "serious health consequences," with 8% saying the result was death, 11% saying the result was long-term disability and 16% citing severe pain (Minneapolis Star Tribune, 11/18).
- Of those who experienced a medical error, 72% say the physician has "a lot" of responsibility for the mistake, and 11% say they sued for malpractice. Among those who said the medical error resulted in serious health consequences, 14% sued for malpractice (Heil, CongressDaily, 11/17).
According to the Star Tribune, U.S. residents' growing concern about the health care system comes "despite widespread efforts by the health care industry to reduce errors." Improvements include more widespread use of electronic health records and electronic prescribing to reduce transcription errors, as well as more time spent educating patients (Minneapolis Star Tribune, 11/17). When asked about causes of medical errors, people were less concerned with such procedural and technical issues, according the Scripps Howard/News.
They said the most important issues affecting medical error rates are workload, stress or fatigue among health professionals; too little time spent with patients; and too few nurses. According to the survey, 79% of the public believes giving doctors more time to spend with patients would be "very effective" at reducing medical errors, while only 51% believes that additional use of EHRs or electronic prescribing would be useful (Scripps Howard/Detroit News, 11/18).
The public had the following responses to reducing medical errors.
- Ninety-two percent believe reporting of serious medical errors should be mandatory, and 63% say the information should be released publicly.
- Eighty-eight percent say that physicians should be required to inform a patient if a preventable medical error resulted in serious harm in the patient's own care (Kaiser Family Foundation release, 11/17).
- Seventy percent believe that information about medical errors would tell them "a lot" about the quality of care in a hospital.
"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 and CEO Drew Altman said (McKelway, Richmond Times-Dispatch, 11/18). Robert Blendon, a professor of health policy and political analysis at Harvard, said, "Few experts would say that medical care is worse than it was five years ago. The public isn't convinced of that." He added, "We're approaching a point where we'll have a greater debate about what information should be given to the public [about medical errors]. Patients want more information than health professionals want to give" (Bloomberg, 11/17).
Blendon also said that the survey shows U.S. residents "do not view the malpractice system as the way to" reduce the medical error rate, calling into question whether policymakers' renewed interest in tort reform is misplaced (Connolly, Washington Post, 11/18). AHRQ Director Carolyn Clancy added, "Our challenge is to show the connection between these kinds of changes and improving the care patients receive" (Scripps Howard/Detroit News, 11/18).
John Nelson, president of the American Medical Association, said, "The survey clearly points to a need for better communication with America's patients on patient safety. What we know for sure is that we can improve the quality of our health care system by passing and implementing patient safety legislation that allows us to all learn from system errors and adverse outcomes" (Richmond Times-Dispatch, 11/18).
David Brailer, national coordinator for health information technology at HHS, said increased use of technology could reduce medical errors. Lucian Leape, an adjunct professor at Harvard, added, "There should be national [health information technology] goals set and we should align our payment and regulation systems with them" (Bloomberg, 11/117). The AHRQ/Kaiser Family Foundation/Harvard School of Public Health report is available online.