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Evidence Mounts: Much Work Still Ahead to Get High Quality, Safe Health Care

In one week (week of October 7, 2013) I was reminded three times that with all the progress we have made in shedding the light on the quality and safety of health care services and providers, we still have so much more to do.

Rosemary Gibson, a tireless advocate for reducing medical harm and waste within the health care system and a colleague of mine when she was with the Robert Wood Johnson Foundation, made a powerful case to actually  "Count the Dead from Medical Harm" in her Huffington Post blog. Rosemary reminds us that in counting the dead we are honoring them and their needless loss, much like we do when we count the dead from wars and terrorism. By knowing the numbers and keeping them ever present in our minds, we are driven to be sure that "it never happens again". But we don't do this with deaths from medical harm.  We often cite the Institute of Medicine's estimate that at least  98,000 die in the US each year due to harm. Rosemary points out that the actual number may be more like 400,000. No one can say this is not a big number and a shame.

In her blog Leah Binder, CEO of the Leapfrog Group and a frequent speaker at MBGH events, credits a recent study by John Birkmeyer and colleagues published in the New England Journal of Medicine, with showing that it is possible to measure and report on surgeon skill. The study finds that patients of surgeons in the bottom skill quartile are "two to three times more likely to die, suffer a complication, need a repeat surgery or be readmitted to the hospital later."  Doesn't this information make you want to know the skill level of the surgeon you or your family use BEFORE the surgical procedure? Birkmeyer's study introduces a way to do that through videos of actual surgical procedures that are reviewed and scored by a panel of peer surgeons. Not a complicated method to know something as important as surgical skill.

Bob Wachter, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco and a member, along with John Birkmeyer and others, of the Leapfrog Group's Blue Ribbon Panel for the Hospital Safety Score, reminds us in his blog post that although the issue of diagnostic errors is beginning to be discussed in patient safety circles, it is not getting the attention it deserves. The Harvard Medical Practice Study, results of which were published in the New England Journal of Medicine in February, 1991 (22 years ago!), found that diagnostic errors accounted for 17% of the adverse events. Wachter also points out that diagnostic errors are usually the number one cause of harm in malpractice cases.  But the challenge is developing a method to identify and measure diagnostic errors and to report them in way that leads to improvement and helps consumers in selection. Wachter pleads with the American Boards of Internal Medicine (ABIM) to champion the focus on reducing diagnostic errors and the need for research to develop reliable and valid measures we can all use.

So there you have it. We still have work to do to recognize and then address the significant numbers of people that die prematurely due to medical harm. We know that surgical skill is directly linked to patient outcomes, but will we scale up the method to measure and report on this skill so we can use the information? And, we must begin to seriously address measuring and reporting diagnostic errors. Employers, as purchasers and as advocates for their employees, must push for more action in all three of these areas. One way MBGH does this is through leading the regional roll-out of the Hospital Safety Score. But this is just a beginning. Without increased advocacy and involvement we are not likely to see much change.



Posted by Cristie Travis at 6:35 AM

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