The New Health Dialogue

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The issue of patient safety is poised to take center stage in the discussion of health care system improvement. One week after the journal Health Affairs released a landmark study indicating adverse medical events are even more common than previously believed, the Centers for Medicare and Medicaid Services (CMS) have launched a multifaceted assault on the problem of medical errors in America. The issue is yet another vital piece of the cost and quality puzzle that the industry must resolve to combat the unchecked rise in national health expenditures.

The Health Affairs study compared three methods for reporting medical errors—voluntary reporting, a system developed by the Agency for Healthcare Research and Quality, and the Institute for Healthcare Improvement’s (IHI) Global Trigger Tool—and found that the IHI method was capable of detecting almost ten times as many errors as the other approaches. In effect, the authors suggest that the most common methods for error detection uncover only a fraction of the errors that actually occur, which has significant implications in terms of excess spending and lives lost in the US health care system.

The Global Trigger Tool is a standardized method for error detection that uses trained clinical investigators to review charts for adverse “triggers,” which prompt further, deeper analysis of outcomes and systemic problems. While capable of more complete investigations than other methods, a downside of the Tool is its human component. Its “chart reviewers” are subject to learning effects as they repeatedly review cases, becoming more capable of finding errors over time, potentially muddling the results of any long-term study of a single hospital or provider group. Nevertheless, the results of the study suggest the continued underreporting of medical errors, despite a decade-long campaign by the Institute of Medicine.

This week, the government announced a new strategy focused on increasing transparency and renewing efforts to encourage hospitals to address the problem. CMS released two years of hospital-specific patient safety data, using Medicare claims from the period between October 2008 and June 2010. For the first time, patients will have access to these critical (and revealing) statistics through on the CMS Hospital Compare website.

Included in the released data are hospital-specific rates for eight hospital-acquired conditions: foreign object retained after surgery, air embolism, blood incompatibility, advanced-stage pressure ulcers, falls and trauma, vascular catheter-associated infection, catheter-associated urinary tract infection, and manifestations of poor glycemic control.

The data allows for comparison of hospitals against each other, as well as against a national benchmark, albeit with some limitations. Complication rates are not adjusted for case mix (the hospital’s patient population), which could potentially impact the frequency of error. There are also concerns that miscoding of complications may lead to inaccurate estimates of the actual complication rate in a particular hospital.

Despite these limitations, the unadjusted hospital-specific data are still useful in providing transparency to patients and to encourage hospital accountability. The availability of such data will inform patients as consumers in the health care market, allowing them to “vote with their feet” and take their business to the safer hospitals.

With the proposed shift from fee-for-service to pay-for-performance models, vast quantities of health care quality data are going to be produced in the coming years. Consumers must push for these data to become publically available just like these initial safety measure.

HHS Secretary Sebelius and CMS Administrator Don Berwick spoke at a press conference to launch Partnership for Patients, a “new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans.” The Partnership will use funding from the Affordable Care Act in the pursuit of two major goals: reducing the frequency of hospital-acquired conditions by 40 percent, and hospital readmissions by 20 percent. Achieving these goals would correspond to nearly 2 million fewer patient injuries, 60,000 fewer patient deaths, and $35 billion in health care savings over 3 years -- of which $10 billion would directly benefit Medicare.

Berwick hopes to achieve these reductions by the adoption of “well-established, evidence-based interventions that are known to reduce harm to patients and to reduce preventable readmissions,” asking “if there, why not anywhere?”

By promoting the adoption of best practices across the full spectrum of the medical system, CMS and other stakeholders hope to bring a swift end to the present era of unnecessary, expensive, and deadly medical errors.