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    Measuring Harm in Health Care: Optimizing Adverse Event Review

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    Authors
    Walsh, Kathleen E.
    Harik, Polina
    Mazor, Kathleen M.
    Perfetto, Deborah
    Anatchkova, Milena D.
    Biggins, Colleen
    Wagner, Joann
    Schoettker, Pamela J.
    Firneno, Cassandra
    Klugman, Robert
    Tjia, Jennifer
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    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2017-04-01
    Keywords
    patient safety
    generalizability theory
    healthcare associated harm
    Health Services Administration
    Health Services Research
    
    Metadata
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    Link to Full Text
    https://doi.org/10.1097/MLR.0000000000000679
    Abstract
    OBJECTIVE: The objective of this study was to identify modifiable factors that improve the reliability of ratings of severity of health care-associated harm in clinical practice improvement and research. METHODS: A diverse group of clinicians rated 8 types of adverse events: blood product, device or medical/surgical supply, fall, health care-associated infection, medication, perinatal, pressure ulcer, surgery. We used a generalizability theory framework to estimate the impact of number of raters, rater experience, and rater provider type on reliability. RESULTS: Pharmacists were slightly more precise and consistent in their ratings than either physicians or nurses. For example, to achieve high reliability of 0.83, 3 physicians could be replaced by 2 pharmacists without loss in precision of measurement. If only 1 rater was available for rating, approximately 5% of the reviews for severe harm would have been incorrectly categorized. Reliability was greatly improved with 2 reviewers. CONCLUSIONS: We identified factors that influence the reliability of clinician reviews of health care-associated harm. Our novel use of generalizability analyses improved our understanding of how differences affect reliability. This approach was useful in optimizing resource utilization when selecting raters to assess harm and may have similar applications in other settings in health care.
    Source

    Med Care. 2017 Apr;55(4):436-441. doi: 10.1097/MLR.0000000000000679. Link to article on publisher's site

    DOI
    10.1097/MLR.0000000000000679
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/29120
    PubMed ID
    27906769
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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1097/MLR.0000000000000679
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