Thursday, May 5, 2011

Health Reform: Statistics, Medical Errors, and Hospital Deaths

May 5, 2011 - Ordinarily I do not write about statistics . Today will be an exception. The April issue of Health Affairs carries an article ”The $17.1 billion Problem: The Annual Cost of Measurable Medical Errors.”

What does $17.1 billion mean in the scheme of things? From the article’s abstract, I learned $17.1 billion was 0.72% of the $2,391 trillion spent in 2008 on health care.

The 0.72% leads to this statistics discussion. It so happens 0.72% is between 2 and 3 standard deviations (S.D.) outside the mean (M)of spending.

1) M +/- 1 S.D. accounts for 68.3% of statistical events, with 31.7 % room for error variation.

2) M +/- 2 S.D. accounts for 95.5% of statistical events, with 4.5% room for error variation.

3) M. +/- 3 S.D. accounts for 99.7% of statistical events, with 0.3% room for error.

Still with me? Good. This means 99.28% of money spent medical events was error-free. This is not bad statistically for any system, not bad enough for a sweeping condemnation of America’s hospital system, where the “measurable errors” occurred. There is about 1 chance in 139 for medical error occurring, and a 138/139 chance things will go well without error. Still, one can argue any preventable error is inexcusable and potentially fatal.

The Health Affairs article says 10 errors accounted for two-thirds of errors. The top four errors were drug reactions, bed sores, hospital-acquired infections, and intractable post-laminectomy pain.

According to a widely quoted Institute of Medicine study 10 years ago, about 98,000 Americans die in hospital from medical errors, which was the basis for a Donald Berwick’s inspired successful campaign to save 100.000 lives.

A Health Affairs- Robert Wood Johnson Foundation Health Policy Brief of April 15, 2011 on improving quality and safety in hospitals outlines these statistical consequences of hospital errors.

• $4.4 billion spent.

• On average 1 in 7 Medicare beneficiares are harmed.

• 54.9% of American adults did not receive recommended care.

• 40 wrong surgeries or surgeries on the wrong side of the body are performed every week.

• A $1 billion federal initiative is underway to reduce hospital acquired infections by 40% and preventable re-admissions by 20%.

• Medicaid and Medicare could save $50 billion by preventing hospital acquired infections and re-admissions.

The Health Reform law plan (ACA) intent is to produce a systematic reduction of medical errors through awareness, checklists, patient questions before and after surgery, consistent hand washing and gowning , isolation of patients with infections, guidelines for inserting and withdrawing urinary and vascular catheters, and rapt attention to patients on ventilators and other prominent error-laden events and episodes.

Let us hope the plan succeeds.


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