Abstract
Background: The rate of safety harm self-perceived medical errors and harms reported in the U.S. ambulatory system is not well characterized.Objectives: To determine the prevalence of U.S. adult ambulatory care patient self-perceived safety harms and to gauge the degree of association between harms with various patient characteristics and outcomes.Methods: A large U.S. cross-sectional online survey of 9206 ambulatory care adults was assessed for their perception of medical errors and harms during care (misdiagnosis, mistakes in care, and wrong or delayed treatment) and also included patient demographics, health status, comorbidities, insurance status, income, barriers to care (affordability, transportation, and family and social support), number of visits to primary health care services in the past 12 months, and use of urgent or emergency care in the last 12 months.Results: The overall rate of self-perceived medical errors and harms among adult patients in the ambulatory care setting was 36%. Female patients, independent of age, and those with multiple comorbidities or barriers to care, reported the highest number of medical errors. Utilization of multiple providers was associated with a greater number of reported medical errors, often resulting in changing health care providers. Patients who reported having trouble affording health care or navigating the system to receive care also reported higher levels of harm. They were cared for by multiple providers, often switch providers, and their care is associated with greater utilization of health care resources. Patients reporting the highest rates of harm had greater use of hospital and emergency room care.Conclusions: This large U.S. adult ambulatory care study provides evidence that patient self-perceived medical errors and harms reported by patients are common. Patient self-perceived medical errors and harms occur most commonly in women, with poor health, limitation of activities, and who have three or more comorbidities.
Highlights
The bulk of health care is delivered through the ambulatory care setting
A large U.S cross-sectional online survey of 9206 ambulatory care adults was assessed for their perception of medical errors and harms during care and included patient demographics, health status, comorbidities, insurance status, income, barriers to care, number of visits to primary health care services in the past 12 months, and use of urgent or emergency care in the last 12 months
The majority of health care is delivered through the ambulatory care setting where there remains a small literature base for patient self-perception medical errors and harms
Summary
The bulk of health care is delivered through the ambulatory care setting. Approximately 1 billion patient care visits occur each year in the United States, far outpacing hospital discharges.[1,2] Insufficient monitoring of patient safety may be more evident in the ambulatory care system compared with the institutional setting, thereby placing patients at increased risk of harm.[3]Reasons for an ambulatory care safety disparity may include a wide variety of decentralized settings, lackDepartments of 1Family and Preventative Medicine, 2Pharmacotherapy, and 3Internal Medicine, University of Utah, Salt Lake City, Utah, USA. 4Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 5Hall Partners, Ltd., New York, New York, USA. 6Kantar, San Francisco, California, USA.a David N. The rate of safety harm self-perceived medical errors and harms reported in the U.S ambulatory system is not well characterized. Results: The overall rate of self-perceived medical errors and harms among adult patients in the ambulatory care setting was 36%. Utilization of multiple providers was associated with a greater number of reported medical errors, often resulting in changing health care providers. Patients who reported having trouble affording health care or navigating the system to receive care reported higher levels of harm They were cared for by multiple providers, often switch providers, and their care is associated with greater utilization of health care resources. Conclusions: This large U.S adult ambulatory care study provides evidence that patient self-perceived medical errors and harms reported by patients are common. Patient self-perceived medical errors and harms occur most commonly in women, with poor health, limitation of activities, and who have three or more comorbidities
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