Almost one in five hospital patients was injured by their care, according to a study of 10 U.S. hospitals that found little improvement from industry and government efforts to improve safety.

The six-year study of 2,341 hospital admissions in North Carolina found that 18 percent of patients suffered at least one safety-related incident, ranging from minor injuries with little harm to life-threatening mistakes and fourteen deaths. The rate of injuries did not decrease significantly from 2002 to 2007, researchers reported in the study published Wednesday in the New England Journal of Medicine.

Efforts to improve patient safety intensified in the U.S. after a 1999 report by the Institute of Medicine found that medical errors caused as many as 98,000 deaths and more than 1 million injuries each year. North Carolina hospitals have been active members of a national campaign of medical centers, insurers and government agencies to reduce the mistakes, said Christopher Landrigan, a researcher at Brigham and Women’s Hospital in Boston who led the study.

“The rate is high, but it’s not higher than we expected,” Landrigan said in a Nov. 23 telephone interview. “The main point is things are not getting better. This is a wake-up call for the health-care system to address this issue in a more timely fashion.”

The North Carolina hospitals were chosen because the state is considered a leader in efforts to improve patient safety, said Landrigan. He led the study team from Harvard Medical School-affiliated Brigham and Women’s Hospital in Boston, Stanford University Medical School near Palo Alto, Calif., and the Institute for Healthcare Improvement, a nonprofit research and advocacy group in Cambridge, Mass.

North Carolina has increased its efforts to reduce medical injuries since the study ended in December 2007. The researchers reviewed medical records beginning in January 2002 from 10 hospitals selected at random, Landrigan said.

“Obviously, one harm to one patient is more than we would like to see,” Don Dalton, a spokesman for the North Carolina Hospital Association, a trade group representing 128 hospitals and health systems, said in a telephone interview. “We are proud of the efforts that our hospitals have made across the board to improve their quality.”

Overall, the study found 588 medical injuries were reported involving 423 patients, as some experienced more than one injury. Of the total incidents, 50 were considered life- threatening and 17 resulted in permanent harm, in addition to the 14 deaths attributed to the injuries, the researchers found.

Wider use of electronic medical records and improved methods for tracking patient safety are among the practices that may reduce errors over time, Landrigan said.

“Although the absence of large-scale improvement is a cause for concern, it is not evidence that current efforts to improve safety are futile,” Landrigan and colleagues wrote.

The study confirms that more progress needs to be made nationally, Diane Pinakiewicz, president of the National Patient Safety Foundation in Boston, said in a telephone interview.

“We are a lot better than we were when we first starting hearing about this problem and didn’t understand it,” Pinakiewicz said. “There is a huge amount of work to do, and the improvement rate is not as rapid as we would like it to be.”