Patient safety data is limited

How often are patients harmed during the course of their medical care? Are risks to patients rising or on the decline? How does the safety of care in Massachusetts compare with the rest of the country?

At the Betsy Lehman Center, we are frequently asked questions like these. They are good questions, but the answers are neither easy nor complete. We need more and better data to answer them.

Measurement is the cornerstone of any improvement effort. Most of what is known about patient safety risks and harm is extrapolated from research because existing point-of-care metrics offer only a narrow view. Systems in most hospitals fail to detect and record the vast majority of adverse events that take place in patients’ care.  Though more and more individuals seek care outside hospitals, there are scant measures for risks and harm individuals face in outpatient and long-term care settings.

The call for more useful data comes from three key constituencies:

  • Physicians and health care leaders say that without solid data, it is difficult for them to pinpoint and mitigate key sources of risk to patients.
  • Policymakers focused on improving health care quality and reducing cost need more information about the frequency and severity of medical harm.
  • Consumers, too, lack the tools they need to make more informed choices about their care.

That said, there is enough research and “signal” data to know that improving the safety of care is a pressing public health challenge here as it is elsewhere in the country.

Quantifying patient harm: an overview

What we know How we can learn more
Deaths from medical errors Current estimates suggest about 250,000 people each year die from harm during hospitalizations, which would make medical error the third leading cause of death in the country. Establish a baseline of death and serious injury from medical errors in MA to gauge effectiveness of initiatives to reduce harm.
Incidence of medical errors Nearly 1-in-4 MA adults can cite an experience with a medical error in the last 5 years. Analyze data about when, how and how often these errors occur to target harm-reduction policies and initiatives
Cost of medical harm The cost of added care due to errors was pegged at $17.1 billion nationwide in 2008; the estimate includes only a limited set of measurable costs. Quantify the added cost to patients and the health care system in MA to aid statewide cost-reduction efforts
Hospital stays (generally) Between 18 and 33 out of every 100 patients in a hospital experience an error in their care. 29 percent of Medicare patients in rehabilitation hospitals were harmed. Identify the vulnerabilities in our network of hospitals that potentially expose between 500,000 to 1 million MA hospital patients to harm
Hospital stays (preventable complications) Nationwide, preventable complications declined over a 3-year period ending in 2013. On average, MA hospitals are better at managing most preventable complications than hospitals nationwide. Benchmark MA hospitals against other top-performing states; explore variations across MA hospitals and share earnings from top-performing hospitals
Medication errors Nationally, about 1.5 million people are injured by preventable medication errors. Half of all surgeries involve a medication error – 80% of which were preventable – according to a recent observational study at a MA hospital. Track and analyze information about medication errors in and out of hospital settings in the state, including legislatively-mandated reporting of SADEs (serious adverse drug events)
Harm in outpatient practices About half of all harm occurs in ambulatory settings. 70% of malpractice claims stem from outpatient procedures. 57% of malpractice claims are due to misdiagnoses in the outpatient setting Expand the pool of data about outpatient safety risks using insurance claims data, surveys, trigger tools, social media, etc.

Sources: Makary, Daniel (2016); Blendon (2014); Van Den Bos (2011); Classen (2011); OIG (2016); AHRQ (2014); CHIA (2014); IOM (2006); Nanji (2015); CRICO