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The use of standardized mortality rates (SMRs) to profile hospitals presumes differences in preventable deaths, and at least one health system has suggested measuring preventable death rates of hospitals for comparison across time or in league tables. The influence of reliability on the optimal review number per case note or hospital for such a program has not been explored.

Estimates for preventable death rates using implicit case note reviews by clinicians are quite low, suggesting that SMRs will not work well to rank hospitals, and any misspecification of the risk‐adjustment models will produce a high risk of mislabelling outliers.

Most studies achieve only fair to moderate reliability of the direct assessment of whether a death is preventable, and thus it is likely that substantial numbers of reviews of deaths would be required to distinguish preventable from nonpreventable deaths as part of learning from individual cases, or for profiling hospitals.

Furthermore, population‐ and hospital system–specific data on the variation in preventable deaths or adverse events across the hospitals and providers to be compared are required in order to design a measurement procedure and the number of reviews needed to distinguish between the patients or hospitals.

Context

There is interest in monitoring avoidable or preventable deaths measured directly or indirectly through standardized mortality rates (SMRs). While there have been numerous studies in recent years on adverse events, including preventable deaths, using implicit case note reviews by clinicians, no systematic reviews have aimed to summarize the estimates or the variations in methodologies used to derive these estimates. We reviewed studies that use implicit case note reviews to estimate the range of preventable death rates observed, the measurement characteristics of those estimates, and the measurement procedures used to generate them. We comment on the implications for monitoring SMRs and illustrate a way to calculate the number of reviews needed to establish a reliable estimate of the preventability of one death or the hospital preventable death rate.

Methods

We conducted a systematic review of the literature supplemented by a reanalysis of authors’ previously published and unpublished data and measurement design calculations. We conducted initial searches in PubMed, MEDLINE (OvidSP), and ISI Web of Knowledge in June 2010 and updated them in June 2012 and December 2017. Eligibility criteria included studies of hospital‐wide admissions from general and acute medical wards where preventable death rates are provided or can be estimated and that can provide interobserver variations.

Findings

Twenty‐three studies were included from 1985 to 2017. Recent larger studies suggest consistently low rates of preventable deaths (interquartile range of 3.0%‐6.0% since 2008). Reliability of a single review for distinguishing between individual cases with regard to the preventability of death had a Kappa statistic of 0.10‐0.50 for deaths and 0.21‐0.76 for adverse events. A Kappa of 0.35 would require an average of 8 to 17 reviews of a single case to be precise enough to have confidence in high‐stakes decisions to change care procedures or impose sanctions within a hospital as a result. No study estimated the variation in preventable deaths across hospitals, although we were able to reanalyze one study to obtain an estimate. Based on this estimate, 200 to 300 total case note reviews per hospital could be required to reliably distinguish between hospitals.

The studies displayed considerable heterogeneity: 13/23 studies defined preventable death with a threshold of greater than or equal to four in a six‐category Likert scale and 11/24 involved a two‐stage screening process with nurses at the first stage and physicians at the second. Fifteen studies provided expert clinical review support for reviewer disagreements, advice, and quality control. A “generalist/internist” was the modal physician specialty for reviewers and they received one to three days of generic tools orientation and case note review practice. Methods did not consider the influence of human or environmental factors.

Conclusions

The literature provides limited information about the measurement characteristics of preventable deaths, suggesting that substantial numbers of reviews may be needed to create reliable estimates of preventable deaths at the individual or hospital level. Any operational program would require population‐specific estimates of reliability. Preventable death rates are low, which is likely to make it difficult to use SMRs based on all deaths to validly profile hospitals. The literature provides little information to guide improvements in the measurement procedures.

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Number Citation Analysis
401
Li S, Zhou H, Gong H, Zhao F, Wang J, Liu X, Hu J, Luo Y, Hickford JGH. Identification of the Ovine Keratin-Associated Protein 21-1 Gene and Its Association with Variation in Wool Traits. Animals (Basel) 2019;9:ani9070450. [PMID: 31315271 PMCID: PMC6680380 DOI: 10.3390/ani9070450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 12/27/2022]  Open
402
Albaghdadi A, Leeds IL, Florecki KL, Canner JK, Schneider EB, Sakran JV, Haut ER. Variation in the use of MRI for cervical spine clearance: an opportunity to simultaneously improve clinical care and decrease cost. Trauma Surg Acute Care Open 2019;4:e000336. [PMID: 31392284 PMCID: PMC6660802 DOI: 10.1136/tsaco-2019-000336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/07/2019] [Indexed: 12/03/2022]  Open
403
Georgiev GP, Iliev AA, Dimitrova IN, Kotov GN, Malinova LG, Landzhov BV. Palmaris Longus Muscle Variations: Clinical Significance and Proposal of New Classifications. Folia Med (Plovdiv) 2019;59:289-297. [PMID: 28976893 DOI: 10.1515/folmed-2017-0035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022]  Open
404
Gorkem U, Togrul C. Is There a Need to Alter the Timing of Anti-Müllerian Hormone Measurement During the Menstrual Cycle? Geburtshilfe Frauenheilkd 2019;79:731-737. [PMID: 31303661 PMCID: PMC6620182 DOI: 10.1055/a-0840-3817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/27/2022]  Open
405
Dutrillaux AM, Dutrillaux B. Different behaviour of C-banded peri-centromeric heterochromatin between sex chromosomes and autosomes in Polyphagan beetles. COMPARATIVE CYTOGENETICS 2019;13:179-192. [PMID: 31327988 PMCID: PMC6620206 DOI: 10.3897/compcytogen.v13i2.34746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/21/2019] [Indexed: 06/10/2023]
406
Patient and Provider Variables Associated with Variation in the Systemic Treatment of Advanced Prostate Cancer. UROLOGY PRACTICE 2019;6:234-242. [PMID: 31276025 DOI: 10.1097/upj.0000000000000020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
407
Zhu Z, Sun B, Cai W, Zhou X, Mao Y, Chen C, Wei J, Cao B, Chen C, Chen G, Lei J. Natural variations in the MYB transcription factor MYB31 determine the evolution of extremely pungent peppers. THE NEW PHYTOLOGIST 2019;223:922-938. [PMID: 31087356 DOI: 10.1111/nph.15853] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/05/2019] [Indexed: 05/13/2023]
408
Ostrander EA, Wang GD, Larson G, vonHoldt BM, Davis BW, Jagannathan V, Hitte C, Wayne RK, Zhang YP. Dog10K: an international sequencing effort to advance studies of canine domestication, phenotypes and health. Natl Sci Rev 2019;6:810-824. [PMID: 31598383 PMCID: PMC6776107 DOI: 10.1093/nsr/nwz049] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/14/2019] [Accepted: 04/09/2019] [Indexed: 12/18/2022]  Open
409
La Cava W, Moore JH. Semantic variation operators for multidimensional genetic programming. GENETIC AND EVOLUTIONARY COMPUTATION CONFERENCE : [PROCEEDINGS]. GENETIC AND EVOLUTIONARY COMPUTATION CONFERENCE 2019;2019:1056-1064. [PMID: 35849643 PMCID: PMC9285097 DOI: 10.1145/3321707.3321776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
410
Inter-population variation in the intensity of host manipulation by the fish acanthocephalan Pomphorhynchus tereticollis: are differences driven by predation risk? Parasitology 2019;146:1296-1304. [PMID: 31169092 DOI: 10.1017/s0031182019000520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
411
Madan M, Bagai A, Overgaard CB, Fang J, Koh M, Cantor WJ, Garg P, Natarajan MK, So DYF, Ko DT. Same-Day Discharge After Elective Percutaneous Coronary Interventions in Ontario, Canada. J Am Heart Assoc 2019;8:e012131. [PMID: 31498023 PMCID: PMC6662367 DOI: 10.1161/jaha.119.012131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
412
Dong S, Boyle AP. Predicting functional variants in enhancer and promoter elements using RegulomeDB. Hum Mutat 2019;40:1292-1298. [PMID: 31228310 DOI: 10.1002/humu.23791] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/26/2019] [Accepted: 05/09/2019] [Indexed: 01/07/2023]
413
Awad F, Assrawi E, Jumeau C, Odent S, Despert V, Cam G, Perdriger A, Louvrier C, Cobret L, Copin B, Chantot-Bastaraud S, Duquesnoy P, Piterboth W, Le Jeunne C, Quenum-Miraillet G, Siffroi JP, Georgin-Lavialle S, Grateau G, Legendre M, Giurgea I, Karabina SA, Amselem S. The NLRP3 p.A441V Mutation in NLRP3-AID Pathogenesis: Functional Consequences, Phenotype-Genotype Correlations and Evidence for a Recurrent Mutational Event. ACR Open Rheumatol 2019;1:267-276. [PMID: 31777803 PMCID: PMC6857991 DOI: 10.1002/acr2.1039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]  Open
414
Park HS, Kim WJ, Choi J, Kim HW, Baik JH, Kim YO, Park CW, Yang CW, Jin DC. The effect of vascular access type on intra-access flow volume during hemodialysis. J Vasc Access 2019;20:746-751. [PMID: 31148508 DOI: 10.1177/1129729819850942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]  Open
415
Comparison of Laser Milling Performance against Difficult-To-Cut Alloys: Parametric Significance, Modeling and Optimization for Targeted Material Removal. MATERIALS 2019;12:ma12101674. [PMID: 31126030 PMCID: PMC6567257 DOI: 10.3390/ma12101674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/16/2019] [Accepted: 05/20/2019] [Indexed: 12/02/2022]
416
Arnold SV, O'Brien SM, Vemulapalli S, Cohen DJ, Stebbins A, Brennan JM, Shahian DM, Grover FL, Holmes DR, Thourani VH, Peterson ED, Edwards FH. Inclusion of Functional Status Measures in the Risk Adjustment of 30-Day Mortality After Transcatheter Aortic Valve Replacement: A Report From the Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv 2019;11:581-589. [PMID: 29566805 DOI: 10.1016/j.jcin.2018.01.242] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 10/17/2022]
417
Mehta K, Iwanaga J, Tubbs RS. Absence of the Right Common Iliac Vein with the Right Internal Iliac Vein Arising from the Left Common Iliac Vein: Case Report. Cureus 2019;11:e4575. [PMID: 31281758 PMCID: PMC6605961 DOI: 10.7759/cureus.4575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]  Open
418
Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS. An Unusual Superior Root of the Ansa Cervicalis. Cureus 2019;11:e4558. [PMID: 31281742 PMCID: PMC6597134 DOI: 10.7759/cureus.4558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]  Open
419
Su WT, Xie JQ, Pan XH, Liu JJ, Si JP. [Temporal and spatial variation of polysaccharides and alcohol-soluble extractives of Polygonatum cyrtonema]. ZHONGGUO ZHONG YAO ZA ZHI = ZHONGGUO ZHONGYAO ZAZHI = CHINA JOURNAL OF CHINESE MATERIA MEDICA 2019;44:270-273. [PMID: 30989944 DOI: 10.19540/j.cnki.cjcmm.20181106.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
420
137Cs-Based Variation of Soil Erosion in Vertical Zones of a Small Catchment in Southwestern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019;16:ijerph16081371. [PMID: 30995796 PMCID: PMC6518026 DOI: 10.3390/ijerph16081371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 11/17/2022]
421
Manaseki-Holland S, Lilford RJ, Te AP, Chen YF, Gupta KK, Chilton PJ, Hofer TP. Ranking Hospitals Based on Preventable Hospital Death Rates: A Systematic Review With Implications for Both Direct Measurement and Indirect Measurement Through Standardized Mortality Rates. Milbank Q 2019;97:228-284. [PMID: 30883952 PMCID: PMC6422606 DOI: 10.1111/1468-0009.12375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]  Open
Policy Points
422
Morrison CR, Aubert C, Windsor DM. Variation in Host Plant Usage and Diet Breadth Predict Sibling Preference and Performance in the Neotropical Tortoise Beetle Chelymorpha alternans (Coleoptera: Chrysomelidae: Cassidinae). ENVIRONMENTAL ENTOMOLOGY 2019;48:382-394. [PMID: 30753405 DOI: 10.1093/ee/nvy194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 06/09/2023]
423
Bai L, Wang J, Zhou H, Gong H, Tao J, Hickford JGH. Identification of Ovine KRTAP28-1 and Its Association with Wool Fibre Diameter. Animals (Basel) 2019;9:ani9040142. [PMID: 30987059 PMCID: PMC6523819 DOI: 10.3390/ani9040142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 11/18/2022]  Open
424
Fusch C. Avoiding Postnatal Growth Retardation by Individualized Fortification of Breast Milk: Implications for Somatic and Neurodevelopmental Outcomes. Breastfeed Med 2019;14:S15-S17. [PMID: 30985203 PMCID: PMC6486660 DOI: 10.1089/bfm.2019.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
425
Maxillary second molar with four roots and five canals. J Dent Sci 2019;13:167-171. [PMID: 30895113 PMCID: PMC6388827 DOI: 10.1016/j.jds.2012.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/01/2012] [Indexed: 11/22/2022]  Open
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