Rodney A. Hayward, MD; Timothy P. Hofer, MD, MSc
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Hayward R., Hofer T.; Adverse Events following Discharge from the Hospital. Ann Intern Med. 2004;140:232. doi: 10.7326/0003-4819-140-3-200402030-00021
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Published: Ann Intern Med. 2004;140(3):232.
TO THE EDITOR:
Forster and colleagues (1) reported that preventable adverse events frequently occur after hospital discharge. We do not doubt that this is true to an extent. However, the authors failed to account for serious problems with precision and accuracy in estimates of numbers of preventable adverse events obtained through implicit physician judgments (2-4). Using physician review to classify preventable events can result in substantial overestimates unless data are adjusted to account for the skew and poor reliability of reviewers' estimates of preventability (2-4). We are unsure why Forster and colleagues ignored this well-documented bias, but perhaps they thought the moderate interrater reliability made this adjustment unnecessary. If so, they are incorrect on 2 counts. First, significant overestimation can occur even when interrater reliability is moderate; second, their interrater reliability was probably overestimated because they used discussion to resolve disagreement (5, 6). Although this approach makes intuitive sense, both cognitive psychology theory and empirical evaluations of discussion suggest that this approach achieves only an illusion of improved reliability (5, 6).
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