Summary: Panel 1Consumers and Purchasers
On September 11, 2000, as part of the Government's response
to the Institute of Medicine's landmark November 1999 report,
Err is Human: Building a Safer Health System, the Federal
Quality Interagency Coordination (QuIC) Task Force sponsored a
national summit to help set a research agenda on medical errors
and patient safety. A summary of the Summit follows.
Other Summit information includes: Written Statements of panel testimony, Additional Statements, and Streaming Video.
Panel 1: Consumers and Purchasers
The purpose of hearing from consumers and purchasers was to highlight the very real impact of
errors on patients and their families, as well as on those who purchase care on their behalf, and
to better understand this group's research needs.
Susan Sheridan, Consumer, Boise, ID
Mrs. Sheridan testified that from a consumer's perspective, the health care system is
uncoordinated, confusing, and potentially dangerous. From her own experience with medical
errors suffered by both her son and husband, she raised a number of issues related to medical
treatment and the health care system. She cited the need for consumers to be empowered,
informed, and involved in their health care, and for regulatory agencies to be responsive to
consumers' needs to make for a more user-friendly system. Mrs. Sheridan proposed research in
- To examine how to restore ethics to the American medical system.
- To identify in retrospect what deaths and injuries could have been prevented by
mandatory hospital policies and procedures.
- To establish a system for monitoring, evaluating, and assessing health care.
- To identify the role of consumers in relation to the role of regulatory agencies.
- Specifically, to examine how consumers are informed of their responsibilities to
report medical errors, and whether regulating agencies understand their own
responsibilities to address such reports.
- To define the ethical responsibility and accountability of hospitals to patients
who are victims of medical errors.
Robert Meenan, M.D., M.P.H., M.B.A., The Arthritis Foundation
Dr. Meenan emphasized that future research programs on medical errors should be designed
with a balanced and comprehensive approach that recognizes the importance of chronic
diseases, outpatient care, and alternative medical therapies. He highlighted four research areas
that are important to people with chronic conditions:
- Research should not exclusively focus on fatal diseases, but should also
consider chronic illnesses (e.g., arthritis) that reduce quality of life and impose
economic burdens at both the personal and societal levels.
- Research should not overemphasize issues of inpatient care. Given the
substantially larger number of patients who are treated in outpatient settings
than in hospitals, the cumulative burden of outpatient errors is significantly
- Research should not focus exclusively on errors of medications and surgery.
People with chronic illnesses are treated with many other modalities of therapy
(e.g., alternative medicine) whose safety must also be considered.
- Research should not exclusively focus on errors of commission (i.e., errors of
execution and/or planning), but also consider errors of omission, which have an
enormous cumulative impact on health care outcomes.
Steve Wetzell, Buyer's Health Care Action Group, Minnesota, Leapfrog Group Steering Committee
Mr. Wetzell's testimony focused on the business case for employers to advance the cause of
patient safety, and on the effectiveness of purchasers in driving patient safety improvements.
He noted that as the current market stands, there are no incentives for providers to focus on
such important issues. He recommended that research be centered on:
- Determining if there is a business case for purchasers to be interested in
investing in and advancing the patient safety issue. The first component of this
research question is the extent to which errors impact on employee health,
productivity, and absenteeism, as well as the cost of health benefits. The second
component is how safety in ambulatory settings can be measured and
incorporated into purchasing strategies, and how purchasers can change their
purchasing practices to reduce errors in outpatient settings.
- Determining the effectiveness of purchaser efforts in driving improvements in
- Identifying incentives (e.g., positive or negative, financial or non-financial) that
can drive health care providers to improve the quality of health care they
- Finding out how to engage consumers to make them more informed
decision-makers in their own health care, so they can have the tools and
knowledge to protect their interests in the marketplace.
- Comprehensively and systematically reviewing the evidence for enhancing
- Developing guidance for purchasers to improve outpatient safety in ambulatory
Mary Jane England, M.D., Washington Business Group on Health
Dr. England proposed a research agenda to focus on assisting employers in understanding how
they can help reduce outpatient medication errors. She recommended the exploration of three
- The safety of ambulatory medications, specifically to determine the magnitude
of the problem in terms of total costs of medication errors and inefficiencies, as
well as morbidities resulting from such errors.
- The development of employer-based demonstration projects to provide
employers with a standardized approach to using existing quality data to
improve medication safety in ambulatory care.
- An examination of the effectiveness of different interventions to improve
ambulatory medication safety.
Gregg Lehman, Ph.D., National Business Coalition on Health
Dr. Lehman's testimony focused on provider payment strategies, and how purchasers can assist
consumers. He recommended four areas of research:
- Research to identify whether health plans currently have safety measures built
into credentialing and contracting standards, and whether employer coalitions
currently request health plans to report on the existence of safety and medical
error reporting systems.
- Research to determine whether managed care poses special safety issues, and to
identify such issues if they exist.
Research to determine how purchasers can assist consumers in identifying
- Research to determine what, if any, economic incentives or provider payment
strategies work best to discourage errors and reward safety.
Question and Answer Session
The following additional areas for research focus were discussed:
- Exploring how standards of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) could become more proactive than reactive.
- Determining how accrediting organizations can play a more consultative role by
identifying best practices in the field and sharing that information with other
- Developing outcomes information in relation to consumers and employees.
Accrediting agencies could learn from other industries and the processes they
have in place to reduce Occupational Safety and Health Administration (OSHA) infractions and other kinds of safety issues in the
- Studying how to make consumers aware of their responsibility to review
accrediting agencies' systems or doctors.
- Studying whether after the introduction of computerized physician order entry
systems, savings offset any additional costs (i.e., make a business case).
- Studying how computerized physician order entry systems can reduce adverse
events, and studying such a system's impact on productivity and patient
- Determining how much error can be avoided by giving patients more
information, with a particular focus on the patient health record, and examining
whether an employee, after receiving the information, is able to have the
capacity to affect practitioners' behaviors to reduce the incidence of medical
- Documenting how efforts by organizations, physicians' groups, and hospitals
that invest in improving decision support systems have helped reduce adverse
- Identifying the elements of a safe system (e.g., electronic patient medical record)
and searching for health systems that contain those elements as an approach to
identifying best practices for further study.
- Compiling a compendium of all the evidence-based research already available
into a checklist to which employers can respond.
Current as of September 2000
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