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- Human Factors Engineering 1
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- Quality Improvement Strategies 3
- Technologic Approaches 1
Search results for "Incentives"
Journal Article > Study
Eappen S, Lane BH, Rosenberg B, et al. JAMA. 2013;309:1599-1606.
The business case for patient safety relies on the assumption that adverse events are financially harmful to hospitals over the long term, so up-front investment in safety improvement will eventually result in savings. However, this study cogently demonstrates that—at least for the specific case of surgical complications—hospitals actually profit when patients experience adverse events. Analysis of more than 30,000 surgical procedures revealed that hospitals received significantly greater net reimbursement for patients who experienced complications compared with those who had no complications. This disparity was particularly evident for patients with private insurance, although it was present to a lesser extent for patients with Medicare. This counterintuitive finding vividly demonstrates that, despite efforts such as the Centers for Medicare and Medicaid Services' policy of not paying for errors, payment incentives are not aligned to the extent that would truly encourage innovative approaches to improving safety. As the noted health economist Dr. Uwe Reinhart points out in his accompanying editorial, the findings of this study arise directly from a payment system that rewards providers for the volume rather than the quality of service provided.
Journal Article > Review
Mittmann N, Koo M, Daneman N, et al. Drug Healthc Patient Saf. 2012;4:141-165.
This systematic review attempted to quantify the excess attributable cost of patient safety events in hospital care but found considerable methodologic weaknesses in the available literature addressing this question.
Perspectives on Safety > Perspective
with commentary by Barry M. Manuel, MD; Jack L. McCarthy; William Berry, MD, MPH; Kathy Dwyer, Risk Management and Patient Safety, December 2010
In 1990, a Harvard-based research team reported the incidence of medical errors in the state of New York, based on the hospital discharge analysis of 30,121 cases.
Journal Article > Study
Who pays for medical errors? An analysis of adverse event costs, the medical liability system, and incentives for patient safety improvement.
Mello MM, Studdert DM, Thomas EJ, Yoon CS, Brennan TA. J Empirical Leg Stud. 2007;4:835–860.
Organizational costs associated with medical errors, and specifically adverse drug events, have been reported. This study analyzes such costs and also examines what proportion is absorbed by hospitals. Using claims data from a past study, investigators determined that hospitals assumed only 22% of costs associated with injuries. The authors advocate for continued efforts to improve the business case for safety interventions, partly by understanding the marginal costs associated with a given safety improvement. Legal reforms or market interventions are also suggested as mechanisms to deal with the externalization of injury costs.
Perspectives on Safety > Perspective
with commentary by Jill Rosenthal, MPH, State Error Reporting Systems, June 2007
Seven years ago, the Institute of Medicine (IOM) called on states to create mandatory reporting systems as part of a strategy to identify and learn about medical errors and ultimately to improve patient safety. Since then, many states have responded by creating or improving reporting systems to collect information about hospital-based adverse events. These systems can provide states with an opportunity to strengthen their facility oversight functions, safeguard the public, and partner with providers to improve health care quality.
Perspectives on Safety > Interview
State Error Reporting Systems, June 2007
Diane Rydrych, MA, is Assistant Director of the Division of Health Policy at the Minnesota Department of Health, where she oversees their successful and influential adverse health events reporting system. We asked her to speak with us about the Minnesota initiative and some of the broader lessons for state error reporting systems.
The Medication Errors Panel. Sacramento, CA: California State Senate; March 2007.
This report shares findings from an expert panel convened to study the causes of medication error in the outpatient setting and provide recommendations for reducing errors associated with prescription and over-the-counter medications.
Cases & Commentaries
- Spotlight Case
- Web M&M
Peter Lindenauer, MD, MSc; November 2006
A woman with end stage renal disease and heart disease on anticoagulation receives a pneumonia vaccination that causes a large hematoma.
Journal Article > Commentary
Leape LL, Berwick DM. JAMA. 2005;293:2384-2390.
Two of the leaders in the patient safety movement, Lucian Leape and Donald Berwick, share their perspectives on the progress made since the Institute of Medicine's (IOM) release of To Err is Human. They summarize the shifts in thinking that have occurred, from blaming individual physicians towards targeting systems as a method to improve both quality and safety. Discussion includes the evolution of error prevention strategies, the role of interested stakeholders in the safety movement, and the impact of implementing best practices. Barriers to ongoing progress are also shared, including the increasing complexity of health care, a tradition of autonomy in care, and the current financial incentive systems. The authors provide a vision for the next five years with expectations for rapid change in adoption of electronic medical records, teamwork training, and full disclosure to patients. While they applaud several efforts and initiatives, such as the growth of AHRQ-funded research, the authors call for a rededication of providers and policymakers to the cause of patient safety, promoted by increased funding, better alignment of incentives, and the setting of ambitious but achievable safety targets.