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Performance Characteristics of a Methodology to Quantify Adverse Events over Time in Hospitalized Patients
Author(s) -
Sharek Paul J.,
Parry Gareth,
Goldmann Donald,
Bones Kate,
Hackbarth Andrew,
Resar Roger,
Griffin Frances A.,
Rhoda Dale,
Murphy Cathy,
Landrigan Christopher P.
Publication year - 2011
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2010.01156.x
Subject(s) - parry , medical school , griffin , medicine , public health , emergency department , health care , family medicine , epidemiology , pediatrics , medical education , history , classics , nursing , political science , computer science , law , artificial intelligence
Objective. To assess the performance characteristics of the Institute for Healthcare Improvement Global Trigger Tool (GTT) to determine its reliability for tracking local and national adverse event rates. Data Sources. Primary data from 2008 chart reviews. Study Design. A retrospective study in a stratified random sample of 10 North Carolina hospitals. Hospital‐based (internal) and contract research organization–hired (external) reviewers used the GTT to identify adverse events in the same 10 randomly selected medical records per hospital in each quarter from January 2002 through December 2007. Data Collection/Extraction. Interrater and intrarater reliability was assessed using κ statistics on 10 percent and 5 percent, respectively, of selected medical records. Additionally, experienced GTT users reviewed 10 percent of records to calculate internal and external teams' sensitivity and specificity. Principal Findings. Eighty‐eight to 98 percent of the targeted 2,400 medical records were reviewed. The reliability of the GTT to detect the presence, number, and severity of adverse events varied from κ =0.40 to 0.60. When compared with a team of experienced reviewers, the internal teams' sensitivity (49 percent) and specificity (94 percent) exceeded the external teams' (34 and 93 percent), as did their performance on all other metrics. Conclusions. The high specificity, moderate sensitivity, and favorable interrater and intrarater reliability of the GTT make it appropriate for tracking local and national adverse event rates. The strong performance of hospital‐based reviewers supports their use in future studies.