Viewpoints in JAMA

Preventing Patient Harms Through Systems of Care


Peter J. Pronovost, M.D., Ph.D., of the Johns Hopkins Medical Institutions, Baltimore, and George W. Bo-Linn, M.D., M.H.A., of the Gordon and Betty Moore Foundation, Palo Alto, Calif., discuss the problem of preventable harms to patients, which include adverse drug events, catheter-associated urinary tract infections, central line-associated bloodstream infections, and pressure ulcers. The authors suggest “clinicians can reduce patient harm in the same way that engineers manage dynamic complexity: as a systems problem that requires an interdisciplinary systems solution.”

“It is time for the science of health care delivery to mature and embrace systems engineering. It is time for health care to embrace the compelling goal of reducing preventable patient harm. By systematically addressing all the known harms patients may experience, clinicians may realize this goal and, by doing so, improve health care and reduce costs of care, ultimately improving value for the nation and its citizens.”

(JAMA. 2012;308[8]:769-770.


Transforming Quality of Care and Improving Outcomes After Acute Ml - Lessons From the National Registry of Myocardial Infarction

William J. French, M.D., of the Harbor-UCLA Medical Center, Torrance, Calif., and colleagues write that the “National Registry of Myocardial Infarction (NRMI) was the leading cardiovascular disease (CVD) patient registry from 1990 to 2006 in both size and duration. Notably, the various analyses and publications that resulted from the NRMI had direct and substantial effects in improving quality care for acute myocardial infarction treatment in the United States.” In this Viewpoint, the authors discuss the history of the NRMI, and building on the NRMI model.

“As health care practice and treatment options evolve, patient registries remain an important tool for evaluating the interface among patients, physicians, and sites of care. The NRMI was a remarkable achievement and unexpectedly successful in transforming CVD care, in part because it set a high standard for observational research and met an emerging need in the U.S. health care system. The legacy of the NRMI is a model to build upon.”

(JAMA. 2012;308[8]:771-772.


The Value of Statistical Analysis Plans in Observational Research - Defining High-Quality Research From the Start


Laine Thomas, Ph.D., of the Duke University School of Medicine, Durham, N.C., and Eric D. Peterson, M.D., M.P.H., of the Duke Clinical Research Institute, and Contributing Editor, JAMA, suggest that there needs to be improvement in defining standards for reporting observational research, and that “the concepts for improving observational research can be operationalized via use of a formal, prospectively defined statistical analysis plan (SAP).” The authors discuss the development and potential benefits of the use of an SAP.

“The process of writing and submitting an SAP captures many of the attributes of clinical trials, without excessive rigidity that would inhibit exploratory research. It requires extra work on the front end but greater efficiency and clarity in producing and reporting results. Current practice may be augmented by making the SAP publicly available as online ancillary material. This would allow readers to confirm and, if desired, replicate the methods used in the study.”

(JAMA. 2012;308[8]:773-774