Earlier this month, NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health released the results (PDF) of a poll they conducted to learn about the experiences of the 27% of US adults who reported having serious healthcare needs (specifically, those who’d been hospitalized overnight in the past year or who reported having an illness, medical condition, injury, or disability that requires lots of medical care). It’s no surprise that many of the poll respondents reported serious problems with healthcare costs, which sometimes resulted in them not getting needed care. But around two-thirds of the poll respondents also told pollsters they think there’s a serious problem with the quality of healthcare in this country. Here are a few of the poll’s findings on perceptions of quality:
- 13% of respondents believe they received the wrong diagnosis, treatment, or test.
- 25% report that a health professional didn’t give them all the necessary information about a treatment or prescription.
- 34% of those who were hospitalized over the past 12 months say nurses weren’t available when they needed them, or didn’t respond quickly to requests for help.
In considering these findings, it’s important to remember that patients usually don’t have the training to know whether they got appropriate treatment or information – a finding that 13% of people think they got an incorrect diagnosis, treatment, or test isn’t the same as a finding that 13% of people didn’t get appropriate care. But research using data other than patient surveys also finds an appallingly high rate of medical errors.
Back in 1999, the Institute of Medicine sounded an alarm with its publication To Err is Human: Building a Safer Health System, which reported that between 44,000 and 98,000 people die each year in US hospitals (not the healthcare system as a whole) from preventable medical errors. These include errors in diagnosis, treatment, and inadequate prophylactic treatment or follow-up. Despite efforts to improve healthcare quality since then, researchers continue to find high rates of error. For instance, a study by Jill Van Den Bos and colleagues, published in Health Affairs last year, found measurable medical errors cost the US healthcare system $17.1 billion in 2008. The study notes that the Agency of Healthcare Research and Quality’s Patient Safety Initiative identified factors that contribute to medical errors, and these include poor adherence to procedures and guidelines, incomplete assessment and inadequate policies and procedures.
The “sick Americans” who responded to the poll had some thoughts about the causes of healthcare quality problems:
- 65% of respondents see the quality of care as a “very serious” or “somewhat serious” problem (45% and 20%, respectively).
- 74% think a major reason for quality problems is many people not being able to access the existing high-quality doctors and hospitals.
- 63% think a major reason is people not getting the tests or drugs they need.
- 72% want their doctors to take time to discuss broader health issues with them.
Responses weren’t uniformly grim; 47% were “very satisfied” with their care, and 59% think they get good healthcare value for their money. But overall, the poll adds to the evidence that our healthcare system needs major changes in order to ensure access to high-quality care across the US population. Several aspects of the Affordable Care Act aim to shift incentives toward quality rather than quantity of care, but the law’s future is still up in the air.
NPR has aired several stories related to these poll results over the past week:
- “Poll: What It’s Like to be Sick in America,” All Things Considered, 5/21/12
- “Your Stories of Being Sick in the US Health Care System,” Morning Edition, 5/21/12
- “By Putting Patients First, Hospital Tries to Make Care More Personal,” All Things Considered, 5/23/12
- “Changing Hospitals to Treat Patients Better,” Talk of the Nation, 5/24/12
- “What’s Up, Doc? When Your Doctor Rushes Like the Road Runner,” All Things Considered, 5/24/12
- “Need a Nurse? You May Have to Wait,” Morning Edition, 5/25/12
That last one is disturbing in multiple ways — hospital nurses feeling like they can’t so much as sit down for a meal break during a 12-hour shift is a bad sign both for the nurses’ health and for patients’ care.