The Issue
Patients' complaints about adverse events can be used to help understand and address problems with the quality and safety of care. The authors of this Commonwealth Fund–supported study sought to understand how closely complaints track actual injuries and are thus representative of broader quality problems.
What the Study Found
The researchers estimated how frequently adverse events led to complaints to New Zealand's Health and Disability Commissioner and examined the characteristics of patients who did and did not file complaints. They found:
- While only 0.4 percent of all adverse events uncovered through health record review in the New Zealand Quality of Healthcare Study led to complaints, 4 percent of serious, preventable adverse events resulted in complaints.
- The propensity of injured patients to complain increased steeply with severity of injury: the odds of complaint were 11 times greater after serious, permanent injuries, compared with temporary injuries, and 18 times greater after deaths.
- The odds of complaining were significantly lower among the elderly, those of Pacific ethnicity, or the poor.
Conclusions
While most medical injuries do not result in complaints, those that do are severe and thus offer a valuable "window" on threats to patient safety, the authors conclude. The fact that the elderly, those of Pacific ethnicity, and the poor are less likely to complain than other patients raises troubling questions about disparities in access to and use of the complaints process.
