Thursday, October 10, 2013

We Are Behind, or are We ?

It would seem that healthcare is changing rapidly. But has it and is it really ?  The Department of Health and Human Services, Medicare and the Affordable Care Act have mounted a huge and expensive campaign using hype, and a lot of money to convince potential patients that all will be well (or maybe better) with government guidance, incentives, mandates, and a ‘battle plan’ for revolutionizing health care. This was accomplished with preconceived ideas and a partisan plan developed behind closed doors.

Is it so?

Michael L. Millenson reminds us that we are behind. Demanding Medical Excellence came out in October, 1997. What progress has been made since then, and where we have fallen short? He addresses that question in a short article, “The Long Wait for Medical Excellence,”

“I set out to review this topic and found his excellent observations in The Health Care Blog, featuring “Still Demanding Medical Excellence”.

Written at a time  (1997), well before the Institute of Medicine’s (IOM) scathing analysis of dangers in the health system Millenson points out;” the 1998 report on errors from the IOM estimated that 44,000 to 98,000 patients die each year in hospitals from preventable mistakes. The Agency for Healthcare Research and Quality (AHRQ), using a different methodology, recently estimated the number to be 97,000. Put it all together and this is what you’ve got: for the past decade (or, maybe, for several decades), 100,000 Americans (or maybe upwards of 200,000 Americans) have lost their lives each year in hospitals through preventable medical mistakes. Add it up: a million preventable deaths? Two million? Plus preventable injuries? Pick your time frame and your toll.”

In a 2010 Health Affairs blog, “Why We Still Kill Patients,” I bluntly blamed the lack of progress on a combination of errors’ invisible consequences, professional inertia and the income hospitals quietly reap from substandard care. I believe that new standards of transparency, in addition to government and private sector financial incentives, are making care safer.”

All is not lost, just that progress has been very slow as compared to product recalls for defective devices, infectious disease outbreaks. and more.  Perhaps processes and system are more difficult to change. One cannot recall a process without bringing the system to a dead halt.

Now consider that all of the above is about hospital care. Now, consider that 15 years after the IOM error report there is no reliable estimate at all of the death and injury toll in the outpatient environment. Why? And why no outrage?


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