Thomas Eric J, Lipsitz Stuart R, Studdert David M, Brennan Troyen A
Brigham and Women's Hospital and Harvard School of Public Health, Harvard University, Boston, Massachusetts 02115, USA.
Ann Intern Med. 2002 Jun 4;136(11):812-6. doi: 10.7326/0003-4819-136-11-200206040-00009.
The data used by the U.S. Institute of Medicine to estimate deaths from medical errors come from a study that relied on nurse and physician reviews of medical records to detect the errors.
To measure the reliability of medical record review for detecting adverse events and negligent adverse events.
Medical record review.
Hospitalizations in Utah and Colorado in 1992.
After three independent reviews of 500 medical records, the following were measured: reliability and the effect of varying criteria for reviewer confidence in and reviewer agreement about the presence of adverse events.
For agreements in judgments of adverse events among the three sets of reviews, the kappa statistics ranged from 0.40 to 0.41 (95% CIs ranged from 0.30 to 0.51) for adverse events and from 0.19 to 0.23 (CIs, 0.05 to 0.37) for negligent adverse events. Rates for adverse events and for negligent adverse events varied substantially depending on the degree of agreement and the level of confidence that was required among reviewers.
Estimates of adverse event rates from medical record review, including those reported by the Institute of Medicine in its 2000 report on medical errors, are highly sensitive to the degree of consensus and confidence among reviewers.
美国医学研究所用于估计医疗差错导致死亡的数据来自一项研究，该研究依靠护士和医生对病历的审查来发现差错。
衡量病历审查在发现不良事件和疏忽性不良事件方面的可靠性。
病历审查。
1992年在犹他州和科罗拉多州的住院治疗。
在对500份病历进行三次独立审查后，测量了以下内容：可靠性以及审查者对不良事件存在的信心和审查者之间的一致性的不同标准的影响。
在三组审查中，关于不良事件判断的一致性方面，不良事件的kappa统计量范围为0.40至0.41（95%置信区间为0.30至0.51），疏忽性不良事件的kappa统计量范围为0.19至0.23（置信区间为0.05至0.37）。不良事件和疏忽性不良事件的发生率根据审查者之间的一致程度和所需的信心水平有很大差异。
通过病历审查得出的不良事件发生率估计值，包括医学研究所在其2000年关于医疗差错的报告中所报告的那些，对审查者之间的共识程度和信心高度敏感。
