Tuesday, September 25, 2012

New System for Patients to Report Medical Mistakes - NYTimes.com

The Obama administration wants consumers to report medical mistakes and unsafe practices by doctors, hospitals, pharmacists and others who provide treatment.

Hospitals say they are receptive to the idea, despite concerns about malpractice liability and possible financial penalties for poor performance.

In a flier drafted for the project, the government asks: "Have you recently experienced a medical mistake? Do you have concerns about the safety of your health care?" And it urges patients to contact a new "consumer reporting system for patient safety." The government says it will use information submitted by patients to make health care safer.

Federal officials say that medical mistakes often go unreported, and that patients have potentially useful information that could expose reasons for drug mix-ups, surgery on the wrong body part, radiation overdoses and myriad other problems that cause injuries, infections and tens of thousands of deaths each year.

Hospitals and even some doctors say the proposal has merit. "It's a great concept," said Nancy E. Foster, a vice president of the American Hospital Association. "The idea is welcome."

A draft questionnaire asks patients to "tell us the name and address of the doctor, nurse or other health care provider involved in the mistake." And it asks patients for permission to share the reports with health care providers "so they can learn about what went wrong and improve safety."

In seeking White House approval this month for a prototype of the reporting system, Dr. Carolyn M. Clancy, the director of the federal Agency for Healthcare Research and Quality, a part of the Public Health Service, said, "Currently there is no mechanism for consumers to report information about patient safety events."

"Patient reports could complement and enhance reports from providers and thus produce a more complete and accurate understanding of the prevalence and characteristics" of medical errors, Dr. Clancy said.

Federal officials said the reports would be analyzed by researchers from the RAND Corporation and the ECRI Institute, a nonprofit organization that has been investigating medical errors for four decades.

Dr. Kevin J. Bozic, the chairman of the Council on Research and Quality at the American Academy of Orthopaedic Surgeons, said it was important to match the patients' reports with information in medical records.

"Patients' perceptions and experience of care are very important in assessing the overall success of medical treatments," Dr. Bozic said. "However, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge.

"For instance, a patient may say, 'I had an infection after surgery' because the wound was red. But most red wounds are not infected. Or a patient says, 'My hip dislocated' because it made a popping sound. But that's a normal sensation after hip replacement surgery."

Consumer groups welcomed the federal initiative. The American Medical Association had no immediate comment, saying it needed to study the details.

Some research suggests that one-fourth of patients in and out of hospitals experience "adverse events" in their care. Hospital patients interviewed by researchers in Massachusetts reported many events that were not documented in their medical records.

In the reporting system envisioned by the Obama administration, patients and their relatives would report medical errors and near misses through a Web site and in telephone interviews.

For each incident, the government wants to know "what happened; details of the event; when, where, whether there was harm; the type of harm; contributing factors; and whether the patient reported the event and to whom."

The questionnaire asks why the mistake happened and lists possible reasons:

¶ "A doctor, nurse or other health care provider did not communicate well with the patient or the patient's family."

¶ "A health care provider didn't respect the patient's race, language or culture."

¶ "A health care provider didn't seem to care about the patient."

¶ "A health care provider was too busy."

¶ "A health care provider didn't spend enough time with the patient."

¶ "Health care providers failed to work together."

¶ "Health care providers were not aware of care received someplace else."

If the pilot project is cleared by the White House, health officials hope to start collecting information in May. Questionnaires would be made available at kiosks in hospitals and doctors' offices. Fliers describing the project would be given out at pharmacies and mailed to patients' homes with the explanation of benefits sent to them by insurance companies.

Reporting is voluntary, and federal officials said they would keep the information confidential.

A government script for follow-up interviews explains: "A medical mistake or error is an act or omission by a health care provider that most health care providers would consider incorrect at the time it happened. Some, but not all, medical mistakes can result in harm or injury to the patient."

The government wants to know if the mistake involved the wrong medicine, the wrong dose of medicine or reactions to a drug; the wrong test or procedure, the wrong diagnosis or surgery on the wrong body part; or blood clots, infections, problems with anesthesia or "unclean or unsanitary care."

Martin J. Hatlie, the chief executive of Project Patient Care, a health care safety coalition in Chicago, welcomed the federal plan.

"Patients and their families are a potential gold mine of information," Mr. Hatlie said. "They see things that busy health care workers don't see. Doctors are in and out. Nurses are in and out. But relatives are there continuously with the patient. They often know how to fix problems that cause errors."

In recent years, Congress has taken steps to link Medicare and Medicaid payments to the quality of care, prohibiting payment for the treatment of certain medical errors.