February 14, 2011
autism sepsis obesity bariatric surgery intensive behavioral therapy mental health aca affordable care act access sympsoium obamacare narrow networks reference pricing contraceptive exchange health reform health insurance exchanges marketplace fqhc safety net decision making patient engagement electronic health records cms electronic medical records health care cost medicaid michigan small business oregon depression readmissions aco health care costs costs medicare health policy exchanges politics wellness programs rules election courts coverage dual-eligible funding cheboygan memorial communication scotus employers poverty variation cost use quality research policy health insurance acos hmos essential benefits reform sgr congress drugs class long term care va e-prescribing emrs patient safety states for-profit nonprofit block grant tanf welfare reform hospice end of life non-profit evidence-based care waste washtenaw county uninsured population health managed care cancer end-of-life care individual mandate ryan proposal pharmaceutical industry r & d comparative effectiveness research evidence based care quality improvement collaborative quality initiatives cqi pharmaceuticals regulations prematurity heath reform antibiotics overuse geographic variation medical appropriateness health websites imrt radiation therapy medical errors constitutionality translate health care economics rationing insurance regulation incentives cardiology pcmh health disparities british health care system guidelines radiology pain early childhood physician employment dartmouth atlas cover michigan health care coverage insurance preventive care public health
One year ago, the New York Times reported on a series of serious medical errors that had occurred during the administration of Intensity Modulated Radiation Therapy, or IMRT. IMRT is a relatively new technology that uses sophisticated equipment to deliver high doses of radiation to very specific areas of the body, while sparing normal tissue. When administered correctly, IMRT can reduce the toxic effects of radiation therapy and allow higher doses than traditional radiation therapy. However, when this highly targeted beam misses its target due to a medical error, the results can be catastrophic.
The attention generated by the Times article has led to some promising steps in the past year toward better radiation safety in oncology practice. The American Society for Therapeutic Radiation and Oncology (ASTRO) released a six point plan outlining the steps the professional society was going to take to improve safety. And many facilities, including University of Michigan Health System, have made information about the safety procedures they use for radiation therapy available to the public.
Experts agree that accurate and transparent error reporting is necessary to help improve IMRT safety. Error registries allow facilities to learn from each other, and enable systematic study into the factors that allow errors to occur. Some states have been very successful in achieving high rates of error reporting, but what leads to that success is not clear. For example, the state of New York has an error reporting rate 16 times Michigan’s rate.
Michigan has not yet taken the kinds of steps implemented in New York. In Michigan, facilities are only inspected every four to five years, and there are no statewide requirements for safety and quality assurance procedures. Short of stronger regulation in Michigan, approaches like those taken by the University of Michigan Health System could improve safety for IMRT patients and give providers better tools for quality improvement.