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Academia and the Profession |

Preventable Deaths: Who, How Often, and Why?

Robert W. Dubois, MD, PhD; and Robert H. Brook, MD, ScD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by grants from American Medical International, Beverly Hills, California; and the Robert Wood Johnson Foundation, Princeton, New Jersey.

The opinions, conclusions, and proposals in the text are those of the authors and do not necessarily represent the view of American Medical International or the Robert Wood Johnson Foundation.

Requests for Reprints: Robert W. Dubois, MD, PhD, Value Health Sciences, 1448 15th Street, Suite 202, Santa Monica, CA 90404.

Current Author Addresses: Dr. Dubois: Value Health Sciences, 1448 15th Street, Suite 202, Santa Monica, CA 90404.

Dr. Brook: The RAND Corporation, 1700 Main Street, Santa Monica, CA 90406.

Ann Intern Med. 1988;109(7):582-589. doi:10.7326/0003-4819-109-7-582
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If the quality of care provided by a hospital affects its death rate, then some deaths must be preventable. We have developed a new method to investigate this issue and have reviewed 182 deaths from 12 hospitals (6 high outliers and 6 low outliers for death rate) for three conditions (cerebrovascular accident, pneumonia, or myocardial infarction). The investigators prepared a dictated summary of each patient's hospital course. Then, at least three physicians reviewed each summary and independently judged whether the death could have been prevented. Using a majority rules criterion (at least two of three physicians agreed), we found that 27% of the deaths might have been prevented. Using a unanimity criterion (all three physicians independently agreed), we found a 14% rate of probably preventable deaths. Patients whose deaths were probably preventable were younger (74.7 compared with 78.6 years, P < 0.05), less often demented (12% compared with 26%, P < 0.05), and less severely ill (mean Acute Physiology and Chronic Health Evaluation score, 15.6 compared with 21.2; P < 0.001) than patients whose deaths were nonpreventable. The physicians also listed causes for each probably preventable death; nine reasons encompassed almost all of them. For myocardial infarction, preventable deaths reflected errors in management. For cerebrovascular accident, however, deaths primarily reflected errors in diagnosis. The severity of illness can help a hospital retrospectively identify probably preventable deaths. In the group of patients who died, 42% of those with a low severity of illness had probably preventable deaths as compared to 11% admitted with a high severity of illness. We found that a significant number of hospital deaths might have been prevented. Our findings were based on a new method that needs further testing to substantiate its validity. These findings also need replication before they can be generalized to other hospitals.





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