After analyzing medical death rate data over an eight-year stretch, patient safety experts from Johns Hopkins have calculated that over 250,000 deaths are caused by medical error each year in the U.S. The Centers for Disease Control and Prevention (CDC) currently list respiratory disease – responsible for nearly 150,000 deaths each year – as the third leading cause of death in the U.S.
The research team defines medical error as, “an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.” During their study, the team focused their efforts on identifying preventable lethal events.
Following the release of their findings, the researchers urged the CDC in an open letter to add medical errors to its annual list of the top causes of death in the U.S.
According to Martin Makary, M.D., M.P.H, professor of surgery at the Johns Hopkins University School of Medicine, the CDC doesn’t include medical errors in their list of leading causes of death because there isn’t a recognized standard method to collect that data. “The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used,” he said.
Makary and the rest of the team at Johns Hopkins is advocating for updated criteria in order to properly account for all causes of death. Currently, the CDC uses an international form that uses the International Classification of Diseases (ICD) billing codes in order to keep track of causes of death.
According to the research team, the CDC creates its list by using death certificates filled out by coroners, funeral directors, medical examiners, and physicians. The cause of death is assigned an ICD code, and the experts from Johns Hopkins claim that those codes cannot properly account for inadequate skill, poor judgment, communication breakdowns, and diagnostic errors.
The CDC’s chief of the mortality statistics branch Bob Anderson disputes the claims that their coding is the issue. According to him, the codes accurately capture complications from medical care, and that the CDC’s approach is consistent with international guidelines. Changing how they collect data would create issues when comparing the U.S.’s death statistics to other countries.
The researchers examined four studies from 2000 to 2008 that analyzed medical death rate data, including ones by the Agency for Healthcare Research and Quality and the U.S. Department of Health and Human Services’ Office of the Inspector General, and compared them to hospital admission rates from 2013. Based on the 35+ million hospital admissions from 2013, the researchers extrapolated that over 250,000 deaths were caused by medical error. According to them, that equals to roughly 9.5% of all deaths in the U.S. each year.
With those numbers, only heart disease – 611,105 reported deaths – and cancer – 584,881 reported deaths – rank higher on the CDC’s list of leading causes of death in 2013.
“Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities,” says Makary. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves.”
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