Missed Opportunities, Medical Errors Undermine Quality of Care
Originally published by Reuters Health, April 16, 2002
NEW YORK (Reuters Health) — Americans are not getting the quality of care they should because of a lack of adequate systems to ensure proper diagnosis, prevention and treatment, the Commonwealth Fund asserts in a new report.
Based on a national survey of Americans' experiences with the healthcare system, the New York-based foundation cites troubling evidence of an unacceptable rate of medical errors and an overabundance of missed opportunities to improve patients' health. The report echoes troubles cited in two earlier reports by the Institute of Medicine.
The US healthcare system has been "complacent for far too long," asserted Karen Davis, president of The Commonwealth Fund and lead author of the report. "We haven't put emphasize on guaranteeing safety and reaching high standards of care for everyone."
For example, more than one in five Americans say they or a family member experienced a medical or prescription drug error. That translates to an estimated 8.1 million households nationally reporting a medical mishap or prescription drug error that turned out to be a very serious problem, the report said.
The Institute of Medicine's landmark 1999 report, "To Err is Human," estimated that as many as 98,000 people die every year because of a medical error. But the Commonwealth Fund is the first to attach an estimate to the number of American households at risk due to medical errors.
"We're right to be concerned about 48,000 to 98,000 deaths a year, but it goes beyond just deaths," Davis told Reuters Health.
The survey also reveals continuing problems with doctor-patient relationships. Nearly one in five adults (19%) reported having at least one problem communicating with their doctor at their last visit. Some left the office before discussing questions they had about their care, while others said their doctor listened to some or little of what they had to say.
Nearly one in four adults (24%) who saw a doctor in the last two years did not follow the doctor's advice, often because they disagreed with it.
In addition, the report documents many "missed opportunities" to improve patients' quality of life through proper preventive care and follow-up. The survey found, for example, that one in five women 18 and older failed to receive a Pap smear in the past three years. Forty-one percent of men and women 50 and older had not been screened for colon cancer in the past five years.
Forty-five percent of diabetics surveyed failed to receive in the past year the three screenings—eye, foot and blood pressure checks—recommended for people with that disease.
"If we feel that diabetics (should be getting these tests every year), it's pretty alarming that 45% of them don't," Davis said.
"The US healthcare system has no mechanisms in place to ensure that all adults receive preventive care at recommended intervals and are provided with the services required for proper management of chronic conditions, nor does it systemically train and encourage physicians to counsel patients regarding healthy behavior," the report notes.
Overall, only 8% of adults in the survey expressed being dissatisfied with their care. But a closer examination of the responses reveals that almost twice as many of those in fair or poor health, who are likely to be frequent users of the healthcare system, were dissatisfied.
People are losing faith in the healthcare system, in no small part due to past experiences of medical or medication errors, problems communicating with their doctor and poor continuity of care, the authors contend.
"For too long, physicians and hospitals have demonstrated little interest in knowing how they are judged on quality of care, preferring to be blinded by institutional or professional pride," they write. "The reality is that substandard quality is not a problem for just a few disadvantaged patients or a handful of poorly trained physicians—it is pervasive throughout the healthcare system and is the end result of the fact that inadequate mechanisms are in place to ensure quality."
Davis and colleagues conclude by reiterating recommendations for overhauling the nation's healthcare system outlined by the Institute of Medicine in its 2001 report, "Crossing the Quality Chasm: A New Health System for the 21st Century."
"I think we really need to rethink the way we pay for healthcare and reward quality," Davis said.
