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The Chasm in Quality: Select Indicators from Recent Reports Print   Email

  • Between 44,000-98,000 Americans die from medical errors annually (Institute of Medicine, 2000; Thomas et al., 2000; Thomas et al., 1999)
  • Only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions (McGlynn et al., 2003)
  • Medication-related errors for hospitalized patients cost roughly $2 billion annually (Institute of Medicine, 2000; Bates et al., 1997)
  • 41 million uninsured Americans exhibit consistently worse clinical outcomes than the insured, and are at increased risk for dying prematurely (Institute of Medicine, 2002; Institute of Medicine, 2003a)
  • The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years (Balas, 2001; Institute of Medicine, 2003b)
  • 18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them (Chassin, 1997; Institute of Medicine, 2003a)
  • Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents (Institute of Medicine, 2000; Centers for Disease Control and Prevention; National Center for Health Statistics:  Preliminary Data for 1998, 1999)
  • More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately (Institute of Medicine, 2003c; Clark et al., 2000; Joint National Committee on Prevention, 1997; Legorreta et al., 2000; McBride et al., 1998; Ni et al., 1998; Perez-Stable and Fuentes-Afflick, 1998; Samsa et al., 2000; Young et al., 2001) 


Balas, E.A.  2001.  Information Systems Can Prevent Errors and Improve Quality.[Comment].  Journal of the American Medical Informatics Association  8 (4):398-9.

Bates, D.W., N. Spell, D.J. Cullen, E. Burdick, N. Laird, L.A. Petersen, S.D. Small, B.J. Sweitzer, and L.L. Leape.  1997.  The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.  JAMA  277 (4):307-11.

Centers for Disease Control and Prevention (National Center for Health Statistics).  Births and Deaths: Preliminary Data for 1998.  1999.   National Vital Statistics Reports. Washington, D.C.: Department of Health and Human Services.

Chassin, M.R.  1997.  Assessing strategies for quality improvement.  Health Aff (Millwood)  16 (3):151-61.

Clark, C.M., J.E. Fradkin, R.G. Hiss, R.A. Lorenz, F. Vinicor, and E. Warren-Boulton.  2000.  Promoting early diagnosis and treatment of type 2 diabetes: The National Diabetes Education Program.  JAMA  284 (3):363-5.

Institute of Medicine.  2000. To Err Is Human: Building a Safer Health System.   L. T. Kohn, J. M. Corrigan, and M. S. Donaldson, eds. Washington, D.C: National Academy Press.

Ibid.  2002. Care Without Coverage: Too Little, Too Late. Washington, D.C.: National Academy Press.

Ibid.  2003a. Fostering Rapid Advances in Health Care: Learning from System Demonstrations. J. M. Corrigan, A. Greiner, and S. M. Erickson, eds. Washington, D.C.: National Academy Press.

Ibid. 2003b. Health Professions Education: A Bridge to Quality. A. C. Greiner and E. Knebel, eds. Washington, D.C: National Academy Press.

Ibid.  2003c. Priority Areas for National Action: Transforming Health Care Quality. K. Adams and J. M. Corrigan, eds. Washington, D.C.: National Academy Press.

Legorreta, A.P., X. Liu, C.A. Zaher, and D.E. Jatulis.  2000.  Variation in managing asthma: Experience at the medical group level in California.  Am J Manag Care  6 (4): 445-53.

McBride, P., H.G. Schrott, M.B. Plane, G. Underbakke, and R.L. Brown.  1998.  Primary care practice adherence to National Cholesterol Education Program guidelines for patients with coronary heart disease.  Arch Intern Med  158 (11):1238-44.

McGlynn, E.A., S.M. Asch, J. Adams, J. Keesey, J. Hicks, A. DeCristofaro, and E.A. Kerr.  2003.  The Quality of Health Care Delivered to Adults in the United States.[Comment].  New England Journal of Medicine  348 (26):2635-45.

Ni, H., D.J. Nauman, and R.E. Hershberger.  1998.  Managed care and outcomes of hospitalization among elderly patients with congestive heart failure.  Arch Intern Med  158 (11):1231-6.

Perez-Stable, E.J., and E. Fuentes-Afflick.  1998.  Role of clinicians in cigarette smoking prevention.  West J Med  169 (1):23-9.

Samsa, G.P., D.B. Matchar, L.B. Goldstein, A.J. Bonito, L.J. Lux, D.M. Witter, and J. Bian.  2000.  Quality of anticoagulation management among patients with atrial fibrillation: Results of a review of medical records from 2 communities.  Arch Intern Med  160 (7):967-73.

Thomas, E.J., D.M. Studdert, H.R. Burstin, E.J. Orav, T. Zeena, E.J. Williams, K.M. Howard, P.C. Weiler, and T.A. Brennan.  2000.  Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado.[Comment].  Medical Care  38 (3):261-71.

Thomas, E.J., D.M. Studdert, J.P. Newhouse, B.I.W. Zbar, K.M. Howard, E.J. Williams, and T.A. Brennan.  1999.  Costs of medical injuries in Utah and Colorado.  Inquiry  36 (3):255-64.

Young, A.S., R. Klap, C.D. Sherbourne, and K.B. Wells.  2001.  The quality of care for depressive and anxiety disorders in the United States.  Arch Gen Psychiatry  58 (1):55-61.