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The landmark 1999 Institute of Medicine report, To Err is Human: Building a Safer Health System, startled the American public with its revelation that 44,000 to 98,000 people die in hospitals each year due to preventable medical errors. Although many promising government and private programs have been launched to improve patient safety in the past 5 years, the task is far from complete, according to Carolyn Clancy, M.D., Director of the Agency for Healthcare Research and Quality, and her colleagues Drew E. Altman, Ph.D., of the Kaiser Family Foundation, and Robert J. Blendon, Sc.D., of the Harvard School of Public Health.
For instance, the 2004 National Survey on Consumers' Experiences with Patient Safety and Quality Information, which was sponsored by Kaiser, AHRQ, and Harvard, revealed that despite 5 years of focused attention on health care safety, the American public does not feel safer. More than half (55 percent) surveyed said that they are currently dissatisfied with the quality of health care in this country compared with 44 percent 4 years ago. Indeed, 40 percent of respondents said that they believe the quality of care has "gotten worse."
Policymakers, health care professionals, and the public disagree about which medical errors should be publicly reported and what systemwide steps are needed to prevent avoidable harm, note the authors. For instance, physicians see just two approaches as very effective in reducing errors: requiring hospitals to develop systems to avoid medical errors (55 percent) and increasing the number of hospital nurses (51 percent). Fewer physicians agree that it would be effective to limit certain high-risk procedures to high-
volume centers (40 percent), use only physicians trained in intensive care medicine in hospital intensive care units (34 percent), increase the use of computerized ordering systems (23 percent), or convert to electronic medical records (19 percent). The survey also revealed that about 71 percent of the public is in favor of public reporting of information on medical errors, but physicians strongly oppose it, perhaps due to worries about malpractice lawsuits.
Findings from the 2004 survey, which involved more than 2,000 adults across the Nation, also underscore the importance of research on health information technology (health IT). About one-third of those surveyed said that they or a family member had created their own set of medical records to ensure that their health care providers had all of their medical information. Also, more than half of those surveyed felt that having computerized medical records and using computerized systems for ordering drugs and medical tests would be very effective in reducing errors.
As Dr. Clancy points out, health IT has great potential to improve patient safety and reduce medical errors. AHRQ is supporting a substantial research effort to further our understanding of health IT and its integration into everyday health care. In September 2004, AHRQ awarded $139 million in contracts and grants to promote the use of health IT through the development of networks for sharing clinical data, as well as projects for planning, implementing, and demonstrating the value of health IT. Go to www.ahrq.gov/research/hitfact.htm to find out more about AHRQ's health IT initiative.
For details of the article by Drs. Altman, Clancy, and Blendon, see "Improving patient safety—five years after the IOM report," in the November 11, 2004, New England Journal of Medicine 351(20), pp. 2041-2043. Reprints (AHRQ Publication No. 05-R037) are available from the AHRQ Publications Clearinghouse.
Editor's Note: Another AHRQ-supported study on improving patient safety found that physicians are skeptical of the most commonly touted interventions to reduce medical errors, even those that evidence shows to be effective, such as limiting certain high-risk procedures to high-volume hospitals and increasing the use of computers to order drugs and medical tests. For more details, see Rosen, A.B., Blendon, R.J., DesRoches, C.M., and others (2005, February). "Physicians' views of interventions to reduce medical errors: Does evidence of effectiveness matter?" (AHRQ grant T32 HS00020). Academic Medicine 80(2), pp. 189-192.
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