Summary: Panel 1—Consumers and Purchasers

On September 11, 2000, as part of the Government's response to the Institute of Medicine's landmark November 1999 report, To 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.

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 five areas:

• 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 greater.
• 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 patient safety.
• 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 deliver.
• 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 hospital safety.
• Developing guidance for purchasers to improve outpatient safety in ambulatory care settings.

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 specific areas:

• 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 unsafe providers.
• 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 institutions.
• 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 workplace.
• 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 outcomes.
• 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 errors.
• Documenting how efforts by organizations, physicians' groups, and hospitals that invest in improving decision support systems have helped reduce adverse patient consequences.
• 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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