1. Focus Area 17: Medical Product Safety Progress Review November 5, 2003

2. Health Care Quality Framework Source: 2001 Institute of Medicine Report, Envisioning the National Health Care Quality.

3. Estimated Annual Burden  Adverse Medical Events  44,000 to 98,000 deaths  Total national cost: $36.7 to $50 billion  Adverse Drug Events (ADE)  7,000 deaths due to medication error  2 out of 100 admissions experience preventable ADE  Average increased hospital cost of preventable ADE: $4,700 per admission or $ 2 billion nationwide Source: 1999 Institute of Medicine report, To Err Is Human Building a Safer Health System.

4. Leading Causes of Death: 2001 1. Heart disease 2. Malignant neoplasm 3. Cerebrovascular 4. Chronic lower respiratory 5. Unintentional injury 6. Diabetes 7. Influenza and pneumonia 8. Alzheimer’s disease 9. Nephritis 10. Septicemia 700,142 553,768 163,538 123,013 101,537 71,372 62,034 53,852 39,480 Adverse medical events (estimated): 44,000 – 98,000 * Source: CDC, NCHS, National Vital Statistics System. * Institute of Medicine report estimate. Total Number of Deaths: 2,416,425 32,238

5. Number of Emergency Department Visits for Adverse Effects of Medical Treatment 1992 1994 1996 1998 2000 2001 Number of visits (thousands) Note: Data for 1994-2000 are 2-year averages. Source: CDC, NCHS, National Hospital Ambulatory Medical Care Survey.

6. Medical Product Safety Objectives 17-1* Monitoring of adverse medical events: a. associated with medical therapies b. associated with medical devices 17-2* Linked, automated information systems used: a. by health care professionals in hospitals and integrated health systems b. by pharmacists and other dispensers 17-3* Provider review of medication taken by patients 17-4* Receipt of useful information about prescription from pharmacies 17-5 Receipt of oral counseling about medication from: a. prescribers b. dispensers 17-6 Blood donation * Developmental objectives; those in red have new baselines; those in grey have no baselines.

7. Administering -Administer right medication to patient -Administer medication when indicated -Inform patient about medication -Include patient in administration Dispensing -Review order -Process order -Compound/ Prepare drug Prescribing -Diagnostic / Therapeutic decisions made -Medication ordered -Order verified and submitted Monitoring Program - Obtain medication- related history -Document medication history Adverse Drug Events

8. 1998 2001 81.6 77.4 Hospitals with Monitoring Programs for Adverse Medical Drug Events Percent of children’s and general medical surgical hospitals Source: American Society of Health Systems Pharmacists, National Survey of Pharmacy Practice in Acute Care Settings,. Obj. 17-1a: Developmental

9. 2000 2001 2002 2003 Obj. 17-2a: Developmental Percent of health care organizations Source: Health Information and Management Society, Annual HIMSS Leadership Survey. Electronic Medical Record Use by Health Care Providers

10. Percent of managed care and integrated health systems 2001 31 33 Source: American Society of Health Systems Pharmacists, National Survey of Ambulatory Care Responsibilities of Pharmacists in Managed Care and Integrated Systems. 1999 Electronic Medical Record Use by Pharmacists Obj. 17-2a: Developmental

11. Computerized Prescriber Order Entry System Utilization: 2001 Source: American Society of Health Systems Pharmacists, National Survey of Pharmacy Practice in Hospital Settings. Number of beds Total Less than 50 50-99 100-199 200-299 300-399 400 or more Percent of children’s and general medical surgical hospitals Obj. 17-2b: Developmental

12. Percent of patients 2001 74 Receipt of Useful Information about Prescriptions from Pharmacies Source: FDA, National Survey of Prescription Drug Information Provided to Patients. 1998 Obj. 17-4: Developmental Note: 1998 data based on pilot study results.

13. Receipt of Oral Counseling from Prescribers and Pharmacists Percent of patients Pharmacists Prescribers 2000 1998 Obj. 17-5 2010 Target 90 100 30 10 Source: FDA, National Survey of Prescription Medicine Information Received by Consumers. 0 20 24 14 12

14. Blood Donations, Adults 18 Years and Over: 1998 – 2001 Percent Total 2010 Target 19981999 2000 2001 Source: CDC, NCHS, National Health Interview Survey. Obj. 17-6

15. 18-2425-44 45-64 65+ Percent Blood Donations by Age Group: 2001 Source: CDC, NCHS, National Health Interview Survey. Obj. 17-6 2010 Target

16. Blood Donations, Adults 18 Years and Over by Race/Ethnicity and Education: 2001 Percent (age-adjusted) 2010 Target Source: CDC, NCHS, National Health Interview Survey. Total Asian Hispanic Black White Less than high school High school graduate At least some college Obj. 17-6 Note: Asian includes Pacific Islander; Black and White exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Data are age adjusted to the 2000 standard population. Education data are for persons ages 25-64 years. I = 95% confidence interval. Female Male 0 2 4 6 8 10

17. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm