Publications
Healthcare Quality and Safety
Illinois Health Connect and Your Healthcare Plus Case Statement - August 2010
(Monographs & Books)
State tort reforms and hospital malpractice costs - March 2010
This study explored the relation between state medical liability reform measures, hospital malpractice costs, and hospital solvency. It suggests that state malpractice caps are desirable but not essential for improved hospital financial solvency or viability. (Articles)
A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives - December 2009
Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes. (Articles)
Universal Primary Care -- Shovel Ready Health Care Reform - March 2009
Michael Fine, MD and Shannon Brownlee, MS; Primary Care Roundtable Dialogue Series
(Presentations)
How can primary care cross the quality chasm? - March 2009
The chasm between knowledge and practice decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed. If we are to facilitate the production and use of the knowledge needed for primary care to cross IOM’s chasm, major changes are needed. (Articles)
Characterizing breast symptoms in family practice - November 2008
Of patients with breast symptoms only a small subset is subsequently given a diagnosis of breast cancer (3.2%); however, the presence of a breast mass is associated with an elevated likelihood of breast cancer. These data illustrate the use of systematic data collection and classification from primary care offices to extract information regarding disease symptoms and diagnoses. (Articles)
Testing process errors and their harms and consequences reported from family medicine practices - June 2008
Errors occur throughout the testing process, most commonly involving test implementation and reporting results to clinicians. While significant physical harm was rare, adverse consequences for patients were common. The higher prevalence of harm and adverse consequences for minority patients is a troubling disparity needing further investigation. (Articles)
Congruent satisfaction: Is there geographic correlation between patient and physician satisfaction? - January 2007
Despite geographic variation, there is a strong correlation between physician and patient satisfaction living in similar geographic locations. Further analysis of this congruence and examination of areas of incongruence between patient and physician satisfaction may aid in improving the healthcare system. (Articles)
How well do family physicians manage skin lesions? - January 2007
This study demonstrates that most skin lesions seen by office-based family physicians resolve within three months, patients are generally satisfied with the care they receive, and the diagnostic and treatment decisions made by primary care physicians are not significantly different from those of their dermatologic colleagues. (Articles)
Training on the clock: Family medicine residency directors' responses to resident duty hours reform - December 2006
Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered. (Articles)
Learning from different lenses: Reports of medical errors in primary care by clinicians, staff, and patients - September 2006
Clinicians and staff offer different and independently valuable lenses for understanding errors and their outcomes in primary care, but both predominantly reported process- or system-related errors. There is a clear need to find more effective ways to invite patients to report on errors or adverse events. These findings suggest that patient safety organizations authorized by recent legislation should invite reports from a variety of health care workers and staff. (Articles)
The US medical liability system: Evidence for legislative reform - June 2006
Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals. (Articles)
HealthSTAT: Making America's health care more affordable - February 2006
R. Eric Hart, MD; Washington Primary Care Forum #47 (Presentations)
Avoiding and fixing medical errors in general practice: Prevention strategies reported in the Linnaeus Collaboration's Primary Care International Study of Medical Errors - January 2005
In general practitioners’ medical errors reports, a culture of individual blame is more evident than recognised need for systems design. A minority of reports contained specific, pragmatic suggestions for changing healthcare systems to protect patients’ safety. Error reporting systems may be a practical way to generate innovative solutions to potentially harmful problems facing general practice patients.
(Articles)
A string of mistakes: The importance of cascade analysis in describing, counting, and preventing medical errors - August 2004
Cascade analysis of physicians’ error reports is helpful in understanding the precipitant chain of events, but physicians provide incomplete information about how patients are affected. Miscommunication appears to play an important role in propagating diagnostic and treatment mistakes.
(Articles)
Learning from malpractice claims about negligent, adverse events in primary care in the United States - April 2004
Claims data identify conditions and processes where primary health care in the United States is prone to go awry. The burden of severe outcomes and death from malpractice claims made against primary care physicians was greater in primary care outpatient settings than in hospitals. Although these data enhance information about error-related negligent events in primary care, particularly when combined with other primary care data, there are many operating limitations. (Articles)
Family physicians' solutions to common medical errors - March 2003
In two U.S. studies about medical errors in 2000 and 2001, family physicians offered their ideas on how to prevent, avoid, or remedy the five most often reported medical errors. Almost all reports (94 percent) included at least one idea on how to overcome the reported error. These ideas ranged from “do not make errors” (34 percent of all solutions offered to these five error types) to more thoughtfully proposed solutions relating to improved communication mechanisms (30 percent) and ways to provide care differently (26 percent). More education (7 percent) and more resources such as time (2 percent) were other prevention ideas. (One-Pagers)
Types of medical errors commonly reported by family physicians - February 2003
In a group of studies about medical errors in family medicine, the five error types most often observed and reported by U.S. family physicians were: (1) errors in prescribing medications; (2) errors in getting the right laboratory test done for the right patient at the right time; (3) filing system errors; (4) errors in dispensing medications; and (5) errors in responding to abnormal laboratory test results. “Errors in prescribing medications” was the only one of these five error types that was also commonly reported by family physicians in other countries.
(One-Pagers)
Classification of medical errors and preventable adverse events in primary care: A synthesis of the literature - November 2002
Original research on medical errors in the primary care setting consists of a limited number of small studies that offer a rich description of medical errors and preventable adverse events primarily from the physician's viewpoint. We describe a classification derived from these studies that is based on the actual practice of primary care and provides a starting point for future epidemiologic and interventional research. Missing are studies that have a patient, consumer, or other health care provider input. (Articles)
A preliminary taxonomy of medical errors in family practice - September 2002
This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors.
(Articles)
An international taxonomy for errors in general practice: A pilot study - July 2002
This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries. (Articles)
Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? - March 2002
An inability to care for patients is significantly associated with career dissatisfaction. This relationship has implications for the achievement of policy objectives related to access, having a usual source of care and quality. (Articles)
Patients' rights in the United States: From 'down-under' the situation seems upside-down - February 2002
No abstract available. Free full text version available. (Articles)
Family physicians' experiences of their fathers' health care - October 2001
Even patients with a knowledgeable physician family member face challenges in receiving optimal medical care. Patients might receive better treatment if health care systems reinforced the role of an accountable attending physician, encouraged continuity of care, and emphasized the value of knowing the patient as a person. (Articles)
The patient safety grid: Toxic cascades in health care settings - March 2001
The Patient Safety Grid shows the fields where action is necessary in a comprehensive national effort to reduce harm from medical errors. Each segment of the grid is important and connected to others, sometimes forming a toxic cascade. (One-Pagers)
Toxic cascades: A comprehensive way to think about medical errors - March 2001
Current thinking about threats to patient safety caused by medical errors is often focused in hospital on the immediate consequences of mistakes that affect specific aspects of care, such as testing procedures or medications. Some mistakes, however, become apparent distant from where they were committed and only after a lapse in time. The model of a toxic cascade organizes an approach to making U.S. health care safer for patients by locating upstream sources and downstream consequences of errors within a comprehensive, multilevel scheme. (One-Pagers)
Shortchanging adolescents: Room for improvement in preventive care by physicians - February 2001
Adolescents visit physicians infrequently. When they do, few receive counseling on critical adolescent health issues. Both family physicians and pediatricians have room for improvement.
(Articles)