Measuring Preventable Harm: Helping Science Keep Pace With Policy

Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2009; 301(12):1273-5. DOI: 10.1001/jama.2009.388
Source: PubMed


Four years after Sorrel King's daughter, Josie, died from preventable medical errors in 2001,1 King asked us if her daughter would be less likely to die today. We answered by describing the myriad safety programs in hospitals. She abruptly cut us off. King was not interested in what we were doing. She wanted evidence that Josie and other patients were less likely to be harmed by medical care today, but we could not give her this evidence.

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Available from: Elizabeth Colantuoni, Aug 14, 2014
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    • "Rigorous methodological quality includes, among other considerations, data quality and appropriate risk adjustment [15,48]. In this review, data quality assurance was mentioned in only one study [27] and less than one-third of studies used any type of risk adjustment. "
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    ABSTRACT: Introduction Information on complication rates is essential to trauma quality improvement efforts. However, it is unclear which complications are the most clinically relevant. The objective of this study was to evaluate whether there is consensus on the complications that should be used to evaluate the performance of acute care trauma hospitals. Methods We searched the Medline, EMBASE, Cochrane Central, CINAHL, BIOSIS, TRIP and ProQuest databases and included studies using at least one nonfatal outcome to evaluate the performance of acute care trauma hospitals. Data were extracted in duplicate using a piloted electronic data abstraction form. Consensus was considered to be reached if a specific complication was used in ≥ 70% of studies (strong recommendation) or in ≥ 50% of studies (weak recommendation). Results Of 14,521 citations identified, 22 were eligible for inclusion. We observed important heterogeneity in the complications used to evaluate trauma care. Seventy-nine specific complications were identified but none were used in ≥ 70% of studies and only three (pulmonary embolism, deep vein thrombosis, and pneumonia) were used in ≥ 50% of studies. Only one study provided evidence for the clinical relevance of complications used and only five studies (23%) were considered of high methodological quality. Conclusion Based on the results of this review, we can make a weak recommendation on three complications that should be used to evaluate acute care trauma hospitals; pulmonary embolism, deep vein thrombosis, and pneumonia. However, considering the observed disparity in definitions, the lack of clinical justification for the complications used, and the low methodological quality of studies, further research is needed to develop a valid and reliable performance indicator based on complications that can be used to improve the quality and efficiency of trauma care.
    Critical care (London, England) 10/2012; 16(5):R195. DOI:10.1186/cc11680 · 4.48 Impact Factor
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    • "While a goal of zero harm is desirable, this may not always be feasible. Many practicing clinicians are dismayed by general statements about eliminating all harm, but may be more willing to engage in discussions about substantially reducing the risk of or eliminating preventable harm [5]. Therefore, developing a better understanding of the nature of preventable harm could lead to unambiguous communication and superior stakeholder buy-in. "
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    ABSTRACT: Mitigating or reducing the risk of harm associated with the delivery of healthcare is a policy priority. While the risk of harm can be reduced in some instances (i.e. preventable), what constitutes preventable harm remains unclear. A standardized and clear definition of preventable harm is the first step towards safer and more efficient healthcare delivery system. We aimed to summarize the definitions of preventable harm and its conceptualization in healthcare. We conducted a comprehensive electronic search of relevant databases from January 2001 to June 2011 for publications that reported a definition of preventable harm. Only English language publications were included. Definitions were coded for common concepts and themes. We included any study type, both original studies and reviews. Two reviewers screened the references for eligibility and 28% (127/460) were finally included. Data collected from studies included study type, description of the study population and setting, and data corresponding to the outcome of interest. Three reviewers extracted the data. The level of agreement between the reviewers was calculated. One hundred and twenty seven studies were eligible. The three most prevalent preventable harms in the included studies were: medication adverse events (33/127 studies, 26%), central line infections (7/127, 6%) and venous thromboembolism (5/127, 4%). Seven themes or definitions for preventable harm were encountered. The top three were: presence of an identifiable modifiable cause (58/132 definitions, 44%), reasonable adaptation to a process will prevent future recurrence (30/132, 23%), adherence to guidelines (22/132, 16%). Data on the validity or operational characteristic (e.g., accuracy, reproducibility) of definitions were limited. There is limited empirical evidence of the validity and reliability of the available definitions of preventable harm, such that no single one is supported by high quality evidence. The most common definition is "presence of an identifiable, modifiable cause of harm".
    BMC Health Services Research 05/2012; 12(1):128. DOI:10.1186/1472-6963-12-128 · 1.71 Impact Factor
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    • "First, we have to present definitions and criteria for which deaths in the ICU are preventable and which deaths are not [13]. As previously discussed, a nondirected review process, based on the reviewer's own professional judgment, will provide broader information but lower inter-rater reliability; while a criterion-based review process, based on explicit standards, will be less sensitive but will have better reproducibility. "
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    ABSTRACT: Mortality is the most widely measured outcome parameter. Improvement of this outcome parameter in critical care is nowadays expected not to come from new technologies or treatment, but from delivering the right care at the right moment in a safe way. The measurement of mortality as an outcome parameter confronts us with a problem in providing follow-up to the results. Especially when proven structure and process interventions are applied already, the cause of a suboptimal performance cannot be deduced easily. One possibility is to evaluate the causes of death and to judge preventability. In this article we explore the opportunities and difficulties of a tool to evaluate preventable mortality in the ICU.
    Critical care (London, England) 04/2012; 16(2):309. DOI:10.1186/cc11212 · 4.48 Impact Factor
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