When they don't, a medical error can result. The AMA report says that one challenge to studying patients' roles in their care "has been the inherent difficulty in classifying whether a patient made an 'error' versus a bad choice."
Even the forthcoming ICD-10 coding system reflects this distinction, offering eight codes for patient noncompliance, including one for "patient's intentional under-dosing of medication regimen due to financial hardship." The current coding system, ICD-9 has only one.
Wynia says that providers have been "really reluctant to say the patient made an error. After all, the patient is there for your help," and some say it's the provider's job to ensure that the patient knows how to manage themselves when they go home. "Yet in all these studies, the patient's role was a very important factor in (many) ambulatory care adverse outcomes."
3. Reducing Readmissions via Continual Care
There's a big push to see medical treatment as an episode lasting more than just the initial visit. Think accountable care models or medical homes, where the physician, hospital, pharmacist, clinic, and in-home support team all keep track of what each other does for and with the patient over weeks to years.
Now, instead of handing off a patient to the next provider as if care is no longer their responsibility, outpatient clinicians hold each other accountable for what happens to that patient for a much longer term. If something goes wrong, they all will be tracking back to see why.
The emerging use of electronic medical records can link all hospitals, physicians, and nurses with the patient's files, and at least in theory, can prevent errors and speed timing of care.