Holding Hospitals Accountable for Improved Patient Safety: Confidential Reporting of Major Incidents
Notice bibliographique
Résumé
Context: Evidence that the quality of medical care is improved by adverse event reporting is growing, but systemic improvement in patient safety remains uncoordinated and is driven by organizations and states, rather than by any unified plan. Massachusetts requires hospitals to report several types of major incidents to two different agencies, one set of reports are available to the public, the other kept strictly confidential. We analyzed the effect of the confidential reporting and feedback system on the number of reports, their type and whether they contained corrective actions, before and after a letter notifying hospitals of their failure to comply with the reporting statutes was sent in August 2003. This notification clearly held hospitals accountable for improved patient safety.Objective: To assess the changes in the number of reports filed for major incidents and the presence in the reports of corrective actions planned by the hospitals for the year before and two years after the compliance was sent.Design, Setting and Participants: All 1,317 major incident reports (MIRs) submitted in fiscal years 2003, 2004 and 2005 to the Patient Care Assessment Division (PCA) of the Board of Registration in Medicine of Massachusetts from all 94 acute care hospitals in Massachusetts were analyzed, including the presence of corrective actions included in their report to the PCA. MIRs were grouped by fiscal year, because the compliance letter holding hospitals accountable for improved patient safety was sent in FY 2003; thus improvements were expected to be seen from the baseline period of FY 2003, to the two subsequent fiscal years.Main Outcome Measures: Changes in number of reports of serious major incident reports and presence of hospitals' corrective actions included in reports.Results: Immediately following the baseline fiscal year of 2003, there was a large and significant increase in both the number of hospitals submitting at least one report and the mean number of reports submitted per hospital, and both numbers remained at this higher level in the third year. There was a significant increase in reports for fatal/life-threatening incidents as measured by the presence of corrective actions submitted by the hospitals in their reports, but this improvement lagged one year behind the increase in number of reports.Conclusions: The purpose of a mandatory adverse reporting system, holding hospitals accountable for improved patient safety and quality, is demonstrated by significant improvements in reporting compliance and the presence of corrective actions to the PCA during the three-year period examined.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,025 | 0,138 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».