A new study in Health Affairs examines preventable death rates in the United States. Here is the study’s abstract:
We examined trends and patterns of amenable mortality… in the United States compared to those in France, Germany, and the United Kingdom between 1999 and 2007. Americans under age sixty-five during this period had elevated rates of amenable mortality compared to their peers in Europe. For Americans over age sixty-five, declines in amenable mortality slowed relative to their peers in Europe. Overall, amenable mortality rates among men from 1999 to 2007 fell by only 18.5 percent in the United States compared to 36.9 percent in the United Kingdom. Among women, the rates fell by 17.5 percent and 31.9 percent, respectively. Although US men and women had the lowest mortality from treatable cancers among the four countries, deaths from circulatory conditions—chiefly cerebrovascular disease and hypertension—were the main reason amenable death rates remained relatively high in the United States. These findings strengthen the case for reforms that will enable all Americans to receive timely and effective health care.
On the topic of preventable medical errors, research authored by Milliman consultants for the Society of Actuaries estimates that 1.5 million medical injuries in 2008 were associated with a such errors.
Here is an excerpt:
Using medical claim data for a large insured population to extrapolate to the United States population, we estimate that 6.3 million measurable medical injuries occurred in the United States in 2008. In an inpatient setting, seven percent of the admissions in the claim database resulted in some type of medical injury. Of the 6.3 million injuries, we estimate that 1.5 million were associated with a medical error… these errors resulted in over 2,500 excess deaths and over 10 million excess days missed from work due to short-term disability.
A PDF of the entire study, “The Economic Measurement of Medical Errors,” can be downloaded here.
“The Economic Measurement of Medical Errors” was authored by Jon Shreve, Jill Van Den Bos, Travis Gray, Michael Halford, Karan Rustagi, and Eva Ziemkiewicz.
Quality of Care
That’s the qustion posed by The Lancet. The article cites recent articles from Health Affairs and the New England Journal of Medicine.
Who or what is to blame for medical errors and their consequences? Overworked providers, an unnecessarily complex medical system, or uninformed patients? Patients are often handed from one doctor to another and, in the process, communication between providers can break down. Time spent filling out paperwork is time not spent with patients improving the quality of their care. Decision making often does not involve informing a patient about the balance between benefits and harms of individual treatments, or incorporating patients’ goals into planned treatment. And it does not help that existing guidelines allow medical residents in the USA to work on average 28 h more per week than junior doctors in countries of the European Union. US health providers and policy makers must make patients’ safety a national priority. A good start in the right direction will be to implement at the federal level a mandatory and comprehensive nationwide monitoring system to track medical errors.
Quality of Care
A new paper in Health Affairs is drawing attention back to a study we have blogged about before: The cost of medical errors. Bloomberg has the story:
Medical errors that caused harm to patients cost the U.S. $17.1 billion in 2008, according a review by the Seattle consulting firm Milliman Inc. of medical claims from 2001 through 2008 that also was published in the current issue of Health Affairs. Jill Van Den Bos, a Milliman health-care consultant, is the lead author.
The study identified about 564,000 injuries to patients admitted to U.S. hospitals and 1.8 million injuries to people using outpatient services. The most common and most expensive injuries were pressure sores and infections following surgery, Van Den Bos and her colleagues conclude.
The full Bloomberg article includes coverage of this and one other patient safety study in the latest issue of Health Affairs.
And here is the National Journal’s coverage.
And here is coverage from MedPage Today.
Quality of Care
We’ve talked a lot about quality since launching this blog, but most of the discussion has been specific to the healthcare industry. It’s always interesting to see a well-trodden issue through the eyes of an outsider, which is what we have with this article in Quality Digest summarizing the “Year in Quality.” Here’s an excerpt:
Other low points in human endeavor centered in the medical industry. Findings from a study commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman Inc. estimated that measurable, avoidable medical errors cost the U.S. economy $19.5 billion in 2008. Having mulled over the data for a couple of years, 87 percent of the actuaries concluded that reducing medical errors is an effective way to control health care cost trends for the commercial population; 88 percent believe this to be true for the Medicare population.
What other healthcare topics attracted the eye of a publication that devotes a lot more pages to Six Sigma than actuarial science? The Institute of Medicine’s effort to weed out waste and the emergence of new nanotechnology that can help speed diagnostic capabilities also made the cut.
Quality of Care
One idea for improving the medical professional liability environment involes disclosing medical errors. This was explored in the paper, “Retooling Medical Professional Liability.” Here is an excerpt:
Often, all an injured patient and family may really want is to hear an explanation and perhaps apology from the doctor and to receive a reasonable monetary award—one that will see to his or her immediate medical and other needs with regard to recovery from the event. In an effort to facilitate this type of exchange, as many as 35 states and the District of Columbia have passed what are called I’m Sorry laws allowing a physician to discuss openly an adverse outcome with a patient and express empathy.
A new study looks at this dynamic at the health system level. Here are details from a recent article in American Medical News:
One health system that has embraced the practice for nine years has concluded that those fears are unfounded. Disclosing medical errors and offering timely compensation to patients or family members do not increase medical liability lawsuits, according to a new study on the University of Michigan Health System’s disclosure-with-offer program published in the Aug. 17 Annals of Internal Medicine.
Under the program, the health system conducts an internal investigation of all medical error reports, notifies patients and offers compensation when employees are found at fault.
The health system has had fewer lawsuits, lower liability costs and faster resolution of medical-error cases since the policy was implemented in 2001. Although researchers could not definitively link those trends to disclosure, they were able to conclude that instituting the program did not lead to more lawsuits.
Health Leaders looks at a recent report on avoidable medical errors and highlights the most costly such errors. Here are the top ten.
1. Pressure ulcers—374,964 errors, $10,288 per error and $3.858 billion total.
2. Postoperative infections—252,695 errors, $14,548 per error, $3.676 billion total.
3. Mechanical complication of a device, implant or graft—60,380 errors, $18,771 per error, $1.133 billion total.
4. Postlaminectomy syndrome—113,823 errors, $9,863 per error, $1.123 billion total.
5. Hemorrhage complicating a procedure—78,216 errors, $12,272 per error, $960 million total.
6. Infection following infusion, injection, transfusion, vaccination—8,855 errors, $78,083 per error, $691 million total.
7. Pneumothorax—25,559 errors, $24,132 per error, $617 million total.
8. Infection due to central venous catheter—7,062 errors, $83,365 per error, $589 million total.
9. Other complicaitons of internal (biological) (synthetic) prosthetic device, implant and graft—26,783 errors, $17,233 per error and $462 million total.
10. Ventral hernia without mention of obstruction or gangrene—53,810 errors, $8,178 per error and $440 million total.
Read the full article here and the full report here.
Cost, Quality of Care
A new study commissioned by the Society of Actuaries looks at the cost of avoidable medical mistakes and quantifies the economic impact of such mistakes as $19.5 billion annually. Here is a description of the study from the Wall Street Journal:
Medical errors and the problems they can cause — including bed sores, post-op infections and implant or device complications — cost the U.S. economy $19.5 billion in 2008, according to a study released today. (That’s enough to buy almost 1.3 billion copies of The Checklist Manifesto, Atul Gawande’s bestseller on reducing such errors via the lowly checklist.)
The study, commissioned by the Society of Actuaries and carried out by the actuarial and consulting firm Milliman, is based on insurance claims data. The cost estimate includes medical costs, costs associated with increased mortality rate and lost productivity, and covers what the authors describe as a conservative estimate of 1.5 million measurable errors. The report estimates the errors caused more than 2,500 avoidable deaths and over 10 million lost days of work.
The Hill also picks up on this story. Here’s an excerpt:
Preventable medical errors cost the country $19.5 billion in 2008 — or roughly $13,000 for each avoidable case, according to a report published Monday by the Society of Actuaries (SOA).
And that number is likely low, according to consultants at Milliman, who crunched the data.
“We used a conservative methodology and still found 1.5 million measureable medical errors occurred in 2008,” says Jonathan Shreve, an actuary for Milliman who co-authored of the report. “This number includes only the errors that we could identify through claims data, so the total economic impact of medical errors is in fact greater than what we have reported.”
Read the study here.