Quality_08 - The Quality of Medical Care in the United...

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Unformatted text preview: The Quality of Medical Care in the United States PAM 435 April 8, 2008 Objectives 1)How good is medical care in the United States? 1)Why is the quality of care relatively poor given the amount of money we spend on medical care? 3)How can quality be improved? Institute of Medicines To Err is Human Report Successfully Placed Medical Quality on Policy Radar Screen Utah and Colorado study: adverse events occurred in 2.9% of hospital admissions. adverse events resulted in death 6.6% of the time. over half occurred due to a medical error; preventable. translates into 44,000 preventable deaths/year in U.S. New York study (1984): adverse events occurred in 3.7% of admissions. adverse events resulted in death 13.6% of the time. over half occurred due to a medical error; preventable. translates into 98,000 preventable deaths/year in U.S. Hospital deaths due to medical errors are the 8 th leading cause of death in the U.S. Source: Institute of Medicine, 2000. Error is defined as the failure of a planned action to be completed as intended (i.e., error of execution ) or the use of a wrong plan to achieve an aim (i.e., an error of planning ). Not all errors harm a patients health. Those that do are referred to as preventable adverse events. Errors can occur throughout medical treatment spectrum: preventive care diagnosis of medical condition treatment of condition Defining Terms Source: Institute of Medicine, 2000. Adverse Events During Hospitalization for Medicare Patients in 2002 Source: Zhan et al., Health Affairs, September/October 2006. % of additional costs Type of Event Frequency paid by Medicare- Decubitus ulcer 3.40% 15%- Iatrogenic pneumothorax 0.11% 18%- Post-operative hemorrhage 0.34% 24% and hematoma- Post-operative pulmonary 1.19% 26% embolism and deep vein thrombosis- Post-operative sepsis 1.36% 34% Dennis Quaid video How should one define high quality medical care? Process : actions performed by providers Outcomes : change in a patients health attributed to medical care Structure : characteristics of providers; tools/resources available; orga- nizational setting Donabedians Structure-Process-Outcomes Framework Examples : board certifi- cation, care pathways, TQM, IT Example : Example : ordering beta risk-adjusted blockers for mortality rate for AMI patients a hospital/MD Source: Fonarow et al., JAMA, 2007....
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Quality_08 - The Quality of Medical Care in the United...

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