The United States leads six countries in its rate of medical mistakes, an international survey released today found. The study, which looked at healthcare safety, access and care coordination in Australia, Canada, Germany, New Zealand and the United Kingdom, found that the United States also lacks care coordination and has high out-of-pocket costs for healthcare.

The survey, published in the journal Health Affairs and conducted by the Commonwealth Fund, included more than 700 adults from Australia, Canada and New Zealand and 1,500 or more in the United States and the United Kingdom. All adults in the survey rated their health as fair or poor, reported a serious illness or injury in the last two years or reported that they had been hospitalized or had major surgery in the past two years. The survey is the eighth in an annual series of international surveys conducted by Harris Interactive for the Commonwealth Fund.

Thirty-four percent of U.S. survey participants reported at least one of four types of medical errors, while 30 percent of patients in Canada, 27 percent in Australia, 25 percent in New Zealand and 23 percent in Germany said the same. The United Kingdom had the lowest rate of reported medical errors at 22 percent.

All countries in the survey had problems with coordination of care, but U.S. patients who saw four or more doctors in a two-year time period were more likely than those in other countries to report medical errors.

There are also wide disparities among countries in patients' access to a doctor when they are sick or need medical attention. Canada, followed by the United States, had the lowest rate of patients who said they could make a same-day appointment to see a doctor. Patients in Germany and New Zealand reported the best same-day access to a doctor.

In addition, half of all U.S. adults reported that they had gone without care in the past year because of cost, and one-third reported that they had out-of-pocket costs of more than $1,000. Only thirteen percent of U.K. adults reported not seeking care because of cost concerns.

"The findings show that we have a lot to learn from our colleagues," said Carolyn Clancy, MD, director of the U.S. Agency for Healthcare Research and Quality.

No country included in the survey, however, consistently leads or lags in care.

"The findings of often-similar patterns of inadequate communication, transitional care, and safety concerns highlight the challenges of improving performance in an era of ever more complex medical care," the researchers conclude.

IT's role in reducing errors, improving care

Information technology is one of several approaches to improving care, the study's authors found.

"Investment in information technology, including integrated electronic medical records, also offers potential new tools to support patients and physicians with expanded infrastructure capacity to manage care," the authors said in their conclusion.

Technologies such as electronic medical records are some of the ways that countries included in the report are attempting to improve care, according to several senior government officials and health ministers who reacted to the report at a symposium Thursday in Washington, D.C.

AHRQ's Clancy said there is enthusiasm in the United States for using IT and personal health records to improve the coordination of care and reduce errors. Clancy pointed out that several government demonstration programs on improving care for the chronically ill incorporate IT as a component of care.