Preventing Medical Errors: Communicating a Role for Medicare Beneficiaries
Swift, Elaine, K., Koepke, Christopher, P., Ferrer, Jorge, A., Miranda, David, Health Care Financing Review
In November 1999, the Institute of Medicine released a report by Kohn, Corrigan, and Donaldson (1999) in which they stated that medical errors in hospitals account for as many as 98,000 deaths each year. Few studies have attracted as much public attention. According to one survey, 51 percent of Americans "closely followed" news of the report (Kaiser Family Foundation/Harvard School of Public Health, 1999). The reaction is not surprising: Many Americans believe that errors have affected them or a friend or relative (National Patient Safety Foundation, 1997). Still another survey found 61 percent "very concerned" about receiving the wrong medicine, and 56 percent "very concerned" about complications from a medical procedure (American Society of Health System Pharmacists, 1999).
The Federal Government has begun a campaign to educate the public about medical errors by disseminating messages on actions that consumers can take to prevent errors. Using 20 error-reducing activities that the Agency for Healthcare Research and Quality (AHRQ) identified as feasible for consumers to undertake, several Federal agencies concerned with quality in health care met with private organizations to cull a common set of messages to disseminate to consumers (Agency for Healthcare Research and Quality, 2000a). This list, Five Steps to Safer Health Care, has been endorsed by the Quality Interagency Coordination Task Force (2000) and is already in use by the Office of Personnel Management, the Joint Commission to Accredit Healthcare Organizations, and by TRICARE, the military health care system. Both the Five Steps and AHRQ's 20 actions suggest that patients take a pro-active role in their health care by maintaining and providing their health histories, by studying treatment options, and by asking physicians and other providers questions concerning their health care.
Here, we explore how receptive Medicare beneficiaries may be to messages on how to reduce medical errors. Using a focus group methodology, we examined beneficiaries' reactions to messages on error prevention from AHRQ and other sources. We present our findings on which messages beneficiaries ranked high or low, and why. We also discuss the implications for a public health campaign on medical errors.
SOCIAL MARKETING AND THE MEDICARE AUDIENCE
A social marketing approach to public health communication utilizes a customer-centered perspective. Applied to the Medicare program, it calls for viewing beneficiaries as customers with particular needs and beliefs. By better understanding these needs and beliefs, public health campaigns such as the one to reduce medical errors can create strategies and messages to which customers will be more likely to be receptive and responsive (Andreasen, 1995; U.S. Department of Health and Human Services, 2000; Weinreich, 1999).
Social marketers utilize formative and pretest research to understand the customer's perceptions (Andreasen, 1995). Like many social marketing studies, this one consisted of both formative and pretest research. As formative research, it sought to assess the views that Medicare beneficiaries had on medical error prevention. As pretest research, it sought to develop message strategies for reducing these errors.
Medicare customers are particularly important for a campaign aimed at preventing medical errors because they are leading health care consumers. Medicare beneficiaries spend an average of $7,087 per year for health services, compared with $1,814 for the population as a whole (Agency for Healthcare Research and Quality, 2000b). If a campaign succeeded in persuading this population to act to prevent errors, it could positively influence the health system as a whole.
However, this population presents major challenges to a public campaign. Thirty-four million of Medicare's 39 million beneficiaries are age 65 or over, a segment that often rejects the kinds of pro-active health behaviors that a campaign might promote to reduce errors. …