WEDNESDAY, Nov. 17, 2004 (HealthDayNews) -- Five years after the release of a landmark report revealing the human toll that medical errors exact at U.S. hospitals, Americans do not believe the nation's quality of health care has improved, a new survey finds.

Forty percent said health-care quality has gotten worse, while only 17 percent said it has improved. That negative sentiment exists despite public and private efforts to reduce medical mistakes since the Institute of Medicine (IOM) first focused attention on the problem.

Overall, 55 percent are dissatisfied with the quality of care in this country, the survey revealed When a similar question was posed in a 2000 Gallup poll, only 44 percent said they felt that way.

What's more, 48 percent of people in the new survey said they were somewhat or very worried about the safety of medical care they and their family receive, whether from hospitals or any health-care provider. A majority (74 percent) cited health-care providers' workloads, stress and fatigue as a very important cause of medical errors.

"The bottom line, at least to me, is that half of the people remained concerned about the safety of care, and they're more concerned about the quality of care than at the time the IOM report was [released]," said Robert J. Blendon, a professor of health policy at the Harvard School of Public Health, a survey co-sponsor along with the Henry J. Kaiser Family Foundation and the federal Agency for Healthcare Research and Quality.

Leaders of the sponsoring organizations gathered in Washington, D.C., on Wednesday to brief policymakers and reporters on the findings.

The survey is the first broad assessment of public perceptions of quality since the IOM, the nation's independent scientific adviser on health matters, issued its watershed 1999 report, To Err is Human: Building a Safer Health System. That report concluded that hospital-based medical errors, if considered a cause of death in America, would rank as the nation's eighth leading killer overall. At least 44,000 people and as many as 98,000 die in hospitals each year due to preventable medical errors, the report concluded.

The IOM's stunning assessment sent shock waves through the U.S. health-care system, prompting the Clinton administration to convene an advisory panel on health quality. The panel's recommendations led to the establishment of a task force charged with coordinating quality improvement activities in federal health programs. Providers, payers and insurers, reacting to the IOM's wake-up call, began rolling out systems and strategies to avoid harmful or deadly mistakes.

The Joint Commission on Accreditation of Healthcare Organizations also began pushing for reform by setting annual patient safety goals for its accredited hospitals. The new standards are intended to avoid medication mishaps and surgery mix-ups, for example.

Such efforts appear to be largely invisible to the American public. The new survey shows the challenge is not just to improve patient safety, but to convince the public that real progress is being made, Kaiser Family Foundation President Drew Altman said in a statement.

Blendon agreed: "I think what they [the public] heard about over and over again is the deaths and the problems, and not a lot about what is being done."

Hospitals are making some strides, acknowledged Alfred Chiplin, managing attorney in the Washington, D.C., office of the Center for Medicare Advocacy Inc. But there is much more to do, he said. Doctors and nurses must make patient-safety protocols -- such as taking more detailed patient notes or adhering to infection control practices -- part of their daily ritual, he said.

What's more, health-care organizations such as hospitals and insurers need to give consumers better, more user-friendly information to help them make informed choices about their health care, Chiplin said.

"The public perception is one that is grounded in reality and experience and that's legitimate," he said.

The survey of 2,012 adults, conducted over the summer, assessed the public's perception of quality, their personal experiences with medical errors and thoughts on how to reduce those mistakes.

Not surprisingly, people with chronic health conditions (50 percent) were much more likely than those who don't suffer from chronic illnesses (30 percent) to have experienced a medical error in their own care or a family member's care. At least part of the problem is the lack of systems to identify these patients, coordinate their care across multiple providers and help them manage complex medication regimens, Blendon explained.

Overall, 34 percent of adults said they or a family member have experienced a preventable medical error. Of those people, 70 percent said their provider did not tell them a mistake was made. But a vast majority agreed providers should fess up: 88 percent said it should be a requirement.

"I think some level of reporting should be required," Chiplin said, although he conceded that finding a way to do it in a fair and balanced manner may be challenging.

Hospital and doctor groups oppose a mandatory reporting system, saying it would foster a punitive environment in which providers would be loathe to admit their mistakes. But the public's desire for greater disclosure could sway the debate.

"This is the kind of thing a state attorney general is likely to pick up," Blendon said. "They'll want this information made public."

More information

The Agency for Healthcare Research and Quality has tips for consumers on how to prevent medical errors.

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