ArticleBMJ quality & safety2017
Reviewing deaths in British and US hospitals: a study of two scales for assessing preventability.
Article in BMJ quality & safety, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.
- Ranking Hospitals Based on Preventable Hospital Death Rates: A Systematic Review With Implications for Both Direct Measurement and Indirect Measurement Through Standardized Mortality Rates.The Milbank quarterly · 2019Pooled it
- Epidemiologic Characteristics and Management of Sepsis Among Previously Healthy Patients.CHEST critical care · 2025Article
- Quality and patient safety research in pediatric neurosurgery: a review.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2023Review
- Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals.JAMA network open · 2019Article
- Because space matters: conceptual framework to help distinguish slum from non-slum urban areas.BMJ global health · 2019Review
- Hindsight bias critically impacts on clinicians' assessment of care quality in retrospective case note review.Clinical medicine (London, England) · 2019Article
- Adverse event detection by medical record review is reproducible, but the assessment of their preventability is not.PloS one · 2018Article
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Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundStandardised mortality ratios do not provide accurate measures of preventable mortality. This has generated interest in using case notes to assess the preventable component of mortality. But, different methods of measurement have not been compared. We compared the reliability of two scales for assessing preventability and the correspondence between them.
methodsMedical specialists reviewed case notes of patients who had died in hospital, using two instruments: a five-point Likert scale and a continuous (0-100) scale of preventability. To enhance generalisability, we used two different hospital datasets with different types of acute medical patients across different epochs, and in two jurisdictions (UK and USA). We investigated the reliability of measurement and correspondence of preventability estimates across the two scales. Ordinal mixed effects regression methods were used to analyse the Likert scale and to calibrate it against the continuous scale. We report the estimates of the probability a death could have been prevented, accounting for reviewer inconsistency.
resultsCorrespondence between the two scales was strong; the Likert categories explained most of the variation (76% UK, 73% USA) in the continuous scale. Measurement reliability was low, but similar across the two instruments in each dataset (intraclass correlation: 0.27, UK; 0.23, USA). Adjusting for the inconsistency of reviewer judgements reduced the proportion of cases with high preventability, such that the proportion of all deaths judged probably or definitely preventable on the balance of probability was less than 1%.
conclusionsThe correspondence is high between a Likert and a continuous scale, although the low reliability of both would suggest careful measurement design would be needed to use either scale. Few to no cases are above the threshold when using a balance of probability approach to determining a preventable death, and in any case, there is little evidence supporting anything more than an ordinal correspondence between these reviewer estimates of probability and the true probability. Thus, it would be more defensible to use them as an ordinal measure of the quality of care received by patients who died in the hospital.
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Registered trials
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