Identifying adverse events: reflections on an imperfect gold standard after 20 years of patient safety research

Analysis and support of clinical decision makin

Systematic review of economic evaluations and cost analyses of guideline implementation strategies

Objectives To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies; determine their resources use; and recommend methods to improve future studies. Methods Systematic review of economic studies undertaken alongside robust study designs of clinical guideline implementation strategies published (1966-1998). Studies assessed against the BMJ economic evaluations guidelines for each stage of the guideline process (guideline development, implementation and treatment). Results 235 studies were identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient. 38 reported the treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and two guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Conclusions Very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence based guidelines. Keywords: Cost-effectiveness analysis, physician (or health care professional) behaviour, practice guidelines, quality improvement, systematic review.Peer reviewedAuthor versio

Simpson's paradox: how performance measurement can fail even with perfect risk adjustment

Analysis and support of clinical decision makin

Temporal trends in patient safety in the Netherlands: reductions in preventable adverse events or the end of adverse events as a useful metric?

Analysis and support of clinical decision makin

Mortality alerts, actions taken and declining mortality: true effect or regression to the mean?

Analysis and support of clinical decision makin

Using decision aids may improve informed consent for research.

Contains fulltext : 87549.pdf (publisher's version ) (Closed access)This commentary argues that the existing approach towards obtaining informed consent for clinical research may be improved by using decision aids. Problems with the current approach include i) an emphasis on documentation to the detriment of good quality decision-making; ii) ad hoc rather than theory-based research studying how to improve informed consent; and iii) a lack of clarity around what is meant by 'comprehension' and how to measure it. Decision aids, which clearly improve patient treatment decisions but are new to decisions surrounding study participation, have strengths in precisely the areas where the informed consent literature is weak. Decision aids facilitate a process of decision-making, combining clear documentation, exercises to facilitate decision-making, and consultation. They are increasingly informed by theory and clear, empirically-derived standards. Furthermore, decision aid research has clearly defined and operationalized three indicators of good quality decision-making in situations where there is no objectively correct answer: demonstrable knowledge of key aspects of the decision, accurate perceptions of the probabilities of various outcomes, and a match between preferred outcomes and the choice made. We identify outstanding issues and propose a research approach that will determine whether the use of decision aids can improve the informed consent process.1 mei 201

Staff perceptions of incident reporting & organisational learning in healthcare – results of a qualitative study

The paper presents the results of a qualitative study investigating staff perceptions of incident reporting and organisational learning in healthcare. Semi-structured interviews were conducted with 35 healthcare professionals from two National Health Service (NHS) hospitals in England. Thematic analysis identified two main themes: (1) incident reporting does not normally lead to improvements in practice; (2) healthcare professionals rely on a range of informal processes for organisational learning to overcome the limitations of incident reporting. The results suggest that healthcare organisations and regulatory bodies should seek out and support alternative approaches to organisational learning that might complement existing incident reporting systems