How does the United States compare with other countries on measures of patient safety?

In an international survey conducted in six developed countries, the United States ranked last on three of six survey questions that asked about patient safety events or gaps among patients who are sicker and more intensive users of health care.

Why is this important?

Many developed nations are interested in measuring and improving the quality and safety of health care for their citizens. International comparisons might help identify factors giving rise to better performance and stimulate cross-national learning. The Commonwealth Fund has collaborated with four nations—Australia, Canada, New Zealand, and the United Kingdom—to measure and compare health system performance since 1998. Germany joined this group in 2005.

Findings

In a six-nation survey of patients with a high incidence of chronic illness and recent intensive use of the health care system, patients in the United States were more likely than patients in other countries to report mistakes or adverse events and gaps in expert-recommended safe medication management practices (Schoen et al. 2005). Specifically, U.S. patients were:

• More likely to report a recent medication mistake (being given the wrong medication or wrong dose of medication by a doctor, nurse, hospital, or pharmacist in the past two years) than patients in three countries—New Zealand, the United Kingdom, and Germany.
• More likely to report that they had been given incorrect diagnostic or lab test results, or had experienced delays in being notified about abnormal test results, than patients in all five comparison countries (among those who had a blood test, X-rays, or other tests in the past two years).
• More likely to report that they acquired an infection in the hospital than patients in Germany, the best performing country (among those who were hospitalized in the past two years).
• More likely to report that their doctor only sometimes, rarely, or never reviewed their medications (including those prescribed by others) than patients in Germany, the best performing country (among those with a chronic illness).
• More likely to report that their doctor only sometimes, rarely, or never explained the side effects of medications than patients in three countries—Australia, Canada, and New Zealand (among those with a chronic illness).
• More likely to report that no one discussed what medications they were using before being admitted to a hospital than patients in Australia and Germany (among those taking medications before a hospitalization and given new medication at discharge).

Implications

Health care quality is variable within and across countries. No country consistently achieves better performance, suggesting that quality challenges are complex and multifaceted.

Improvement Ideas and Resources

The World Health Organization (WHO) formed a World Alliance for Patient Safety that seeks to "raise awareness and political commitment to improve the safety of care and facilitates the development of patient safety policy and practice in all WHO Member States."

In the United States, the Joint Commission on Accreditation of Healthcare Organizations requires that accredited hospitals perform a process of "medication reconciliation" in which the patient's current medications are compared with medications ordered during the hospital stay, discrepancies are corrected, and the patient's complete medication list is communicated to the patient and the next provider of care at hospital discharge. Hospitals that followed best practices such as these have reported substantial reductions in rates of detected adverse drug events (Rozich and Resar 2001; Smith and Haig 2005).

Measure:

Sicker adults were defined as those ages 18 and older who rated their health as fair or poor; reported that they had a serious illness, injury, or disability that required intensive medical care in the past two years; or reported that in the past two years they had major surgery or had been hospitalized for something other than a normal pregnancy (Schoen et al. 2005). The narrative describes only statistically significant differences in country rates; the rate for the best-ranking country was significantly different from the rate for the worst-ranking country in all comparisons shown in the charts.

Limitations:

Patient-reported data are subject to potential recall bias. Patients' expectations for care and their awareness of patient safety issues may be influenced by cultural factors that vary from country to country.

Source:

The Commonwealth Fund International Health Policy Survey is a telephone survey of random, representative samples of adults in each country conducted by Harris Interactive and its affiliates (Schoen et al. 2005).

References:

* Indicates source of data used in the chart(s).

Rozich, J. D., and R. Resar. 2001. Medication Safety: One Organization's Approach to the Challenge. Journal of Clinical Outcome Management 8 (20): 27–34.

* Schoen, C., R. Osborn, P. T. Huynh et al. 2005. Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries. Health Affairs Web Exclusives. W5-509–W5-525.

Smith, D. S., and K. Haig. 2005. Reduction of Adverse Drug Events and Medication Errors in a Community Hospital Setting. The Nursing Clinics of North America. 40 (1): 25–32.