Kaiser Family Foundation

Reducing Medical Errors

Kaiser Family Foundation

Agency for Healthcare Research and Quality. Oct 2007. National Health Care Quality Report 2007.
This annual report provides baseline data on the quality of health care as measured across four dimensions.

Agency for Healthcare Research and Quality, Medical Errors and Patient Safety.
This webpage provides multiple resources and fact sheets about current knowledge and standards, and actions patients can take in reducing medical errors.

Atlman DE, C Clancy and RJ Blendon. Nov 2004. Improving Patient Safety-Five Years after the IOM Report. New England Journal of Medicine 351:2041–2043.
This article reviews progress and challenges to reducing medical errors. It focuses on changes in Congressional, physician and policy attitudes five years after a 1999 Institute of Medicine Report.

Bleich S, The Commonwealth Fund. July 2005. Medical Errors: Five Years After the IOM Report.
Five years after the IOM report on medical errors, this issue brief reviews progress in the areas of data standards for patient safety information, use of information technology, and patient safety programs.

Devers KJ, HH Pham and G Liu. Mar-April 2004. What is Driving Hospitals’ Patient-Safety Efforts. Health Affairs 23(2):103–115.
Based on the Community Tracking Study (CTS) and interviews with leaders from major community hospitals, this study examines current hospital patient safety initiatives and the results of those initiatives. The interviews focus on what requirements or information motivates hospitals to continue with these initiatives.

Kohn LT, J Corrigan, and MS Donaldson, Eds. 2000. To Err is Human: Building a Safer Health System. Committee on the Quality of Health Care in America. Washington DC: National Academy Press.
This report from the Institute of Medicine focuses the public spotlight on medical errors. It reports data from prior research and provides a national estimate of annual deaths due to medical errors.

Leape LL. Nov 2005. Ethical Issues in Patient Safety. Thoracic Surgery Clinics.
In this article, the author describes the systems approach for preventing medical errors, discussing progress, problems, and ethical issues in the systems approach.

Leape LL and D Berwick. 2005. Five Years After To Err is Human: What Have We Learned? Journal of the American Medical Association 293(19):2384–2390.
Based on recommendations by the Institute of Medicine in a 1999 report, this article discusses today’s subsequent progress and barriers to improving quality of care. It also poses new suggestions for increasing health care quality and advocacy.

National Committee for Quality Assurance. 2006. The Road Ahead: NCQA 2006 Annual Report.
This report gives statistics on the progress and outlook for quality of care initiatives, featuring letters from the National Health Information Technology Coordinator and the Administrator of the Centers for Medicare and Medicaid Services.

National Committee for Quality Assurance. 2007. The State of Health Care Quality 2007.
This annual report provides performance trends over time, tracks variations in patterns of care and provider recommendations for future quality improvement.

Rosenthal MB, RG Frank, Z Li, et al. Oct 2005. Early Experience with Pay-for-Performance: From Concept to Practice. Journal of the American Medical Association 294(14):1788–1793.
Based on administrative reports of physician group quality, this study explores pay-for-performance programs for addressing quality of care.

Schoen C, R Osborn, PT Huynh, et al. Nov 2005. Taking the Pulse of Health Care Systems: Patients with Health Problems in Six Countries. Health Affairs Web Exclusive.
Based on data from Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States, this article compares and contrasts the respective countries’ treatment for chronic conditions and the prevalence of medical errors.

Werner RM and DA Asch. Mar 2005. The Unintended Consequences of Publicly Reporting Quality InformationJournal of the American Medical Association 293(10):1239–1244.
This article discusses the main goals and issues regarding the public reporting of quality information. 

Public Opinion

Agency for Health Care Research and Quality and Kaiser Family Foundation. Dec 2000. National Survey on Americans as Health Care Consumers: An Update on the Role of Quality Information.
This survey of Americans by the Kaiser Family Foundation and the Agency for Health Care Research and Quality (AHRQ) shows that the recent attention to medical errors may have entered the public's consciousness since it is now among the public's leading measures of health care quality.

Kaiser Family Foundation. Nov 2004. National Survey on Consumers' Experiences With Patient Safety and Quality Information — Summary and Chartpack.
This chartpack summarizes key findings from a national survey assesses Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors.

Kaiser Family Foundation and Harvard School of Public Health. 2002. Medical Errors: Practicing Physician and Public Views.
This study by the Harvard School of Public Health and the Kaiser Family Foundation documents the attitudes of doctors and the public about medical errors and their or their families' experiences with medical errors in the course of receiving medical care.

Kaiser Health Poll Report. July-Aug 2003. Public Opinion on Medical Errors.
Nearly half the public say they are very concerned about an error resulting in injury happening to themselves or their family when they receive health care in general (47%), and when they go to a hospital for care (47%). These concerns rank higher than concern about error resulting in injury when flying on commercial airlines (32%) and when purchasing food at the supermarket (30%).

Rowe M. Dec 2004. Doctors’ Responses to Medical ErrorsOncology Hematology  52(3):147–163.
Based on interviews, this paper discusses issues in medical reporting form physicians’ points of view.

Sorokin R, JM Riggio and C Hwang. Mar-April 2005. Attitudes About Patient Safety: A Survey of Physicians-in-Training. American Journal of Medical Quality 20(2):70–77.
Based on a survey of over 300 fourth-year medical students, this study examines upcoming doctors’ opinions about strategies and policies for reducing medical errors.