Section 7

An Agenda for Research in Ambulatory Patient Safety

Synthesis of a multidisciplinary conference to develop an agenda for research in ambulatory patient safety.

Notes (continued)

21 The risk is not absolutely zero. If medical records document that particular threats to safety were known but no effective action taken over a substantial period of time, this information could be used against the organization during determination of fault and cause in a liability action.

22 Heinrich (1941) is cited in a report (analogous to the Institute of Medicine's report To Err is Human) from the United Kingdom, An Organisation with a Memory: Report of an Expert Group on Learning from Adverse Events in the National Health Service, Department of Health. London: The Stationery Office Limited, 2000.

23 The body of knowledge that has developed to explain these multifactorial interactions is called "complexity science." A concise explanation of complexity science is provided in Appendix B (Plsek 2001) of the Institute of Medicine report (Institute of Medicine 2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Additional sources include a four part series of recent articles in the British Medical Journal (Plsek and Greenhalgh 2001, Wilson and Holt 2001, Plsek and Wilson 2001, Fraser and Greenhalgh 2001).

24 The extent to which the VA experience can be generalized is not clear. The VA system is different from other health care systems with respect to both individual liability and the structure of accountability. Patients must sue the Federal Government under the Torts Claims Act. In the event of a settlement or judgment, a peer review panel recommends whether or not individual practitioner(s) should be reported to the National Practitioner Data Bank.

25 See chapters 5 and 7 in the Institute of Medicine's report Crossing the Quality Chasm (Institute of Medicine 2001).

26 To inform and provide a context for designing research, what we know about ambulatory care should be assembled into a conceptual model that includes all the elements of ambulatory care. A complete and accurate conceptual model of ambulatory care would capture the many people and tasks, the key processes and systems, and their interactions, interdependencies and complexity.

27 James and colleagues found that 62 of more than 600 identifiable clinical conditions (and associated clinical processes) accounted for over 90% of hospital-based care delivery. They have also identified about 40 key clinical support processes that account for about 80% of the resource use in support operations such as the clinical laboratory, pharmacy, a nursing unit, an ICU, a procedure suite, a therapy group, etc. (Brent C. James, M.D., M.Stat., personal communication, June 2001).

28 Technology can bring its own risks. Inadequate operator training and equipment maintenance may lead to misuse and malfunction. If a clinician or other person believes that a device or machine essentially eliminates risk, they may be less vigilant and less likely to detect errors as they are happening (Senders 1994, Macklis et al. 1998, Bates et al. 2001).

29 Redistributing responsibilities and tasks among several clinicians working together would also be expected to reduce costs as less costly people do some tasks that physicians would have done—and do them as well or better.

30 A change in this mental model may be quite difficult to achieve so long as the influence of the tort liability system in medicine is so strong. At the least, it will be necessary to erect protective barriers to enable learning from adverse events.

31 Of course, standardized processes must be built to accommodate differences among patients.

32 Analysis of data from MGMA's annual Cost Surveys (1995 ff) and annual Physician Compensation and Production Surveys (1995 ff) for the years 1995-2000; David Gans, personal communication, April 2001; and Gans 2001.

33 Pursuing Perfection: Raising the Bar for Health Care Performance, is a recently launched program of the Robert Wood Johnson Foundation. It is one example of an approach to large scale, sustained, multifaceted research and demonstration projects (see http://www.rwjf.org).

34 Five of Minnesota's largest health plans (Blue Cross Blue Shield of Minnesota, Medica, Preferred One, UCare MN, and HealthPartners) recently agreed to work together as sponsors of the Institute for Clinical Systems Integration to promote and support the use of medical practice guidelines and protocols developed at the Institute (Quality Letter 2001).

35 Information on Virginians Improving Patient Care and Safety is available at www.vipcs.org. The National Patient Safety Foundation (www.npsf.org) incubates regional patient safety coalitions through its Education Program.

36 Betsy Lehman died in 1996 after an overdose of chemotherapy in a Boston Hospital in 1995. Willie King suffered amputation of the "wrong leg" in a Florida Hospital in 1996, after giving informed consent to amputation of his other leg.

37 105 Code of Massachusetts General Laws, ch. 111, sec. 203; ch. 112, sec. 5, ch. 112, sec. 52 (1999).

38 Secretary Thompson Announces HHS Patient Safety Task Force. HHS Press Release, April 23, 2001. Department of Health and Human Services. Washington, DC.

39 HHS Announces $50 Million Investment to Improve Patient Safety. Press Release, October 11, 2001. Agency for Healthcare Research and Quality, Rockville, MD.

40 Remarks of Arnold Milstein, Partnership Symposium 2001: Patient Safety Stories of Success, October 11, 2001, Dallas, TX (see http://www.p4ps.org).

Return to Contents

References

AAAHC Institute for Quality Improvement. Medical Event Reporting: Special Report. Accreditation Association for Ambulatory Health Care, Chicago, IL, Spring 2001.

Agency for Healthcare Research and Quality. AHRQ Research Activities Number 254, October 2001, p. 22-3.

AMA/Specialty Society Medical Liability Project (AMA/SSMLP). Risk Management Principles & Commentaries for the Medical Office. American Medical Association, Chicago, IL, 1990.

American College of Surgeons (ACS). Guidelines for Optimal Ambulatory Surgical Care and Office-based Surgery, 3rd ed. ACS, Chicago, IL, 2000.

American College of Surgeons (ACS). Office surgery regulation: improving patient safety and quality care. Health Policy Brief. ACS, Chicago, IL, October 2000.

Aparasu R, Fliginger S. Inappropriate medication prescribing for the elderly by office-based physicians. Annals of Pharmacotherapy 31(7-8):823-9, 1997.

Avorn J. Improving drug use in elderly patients. Journal of the American Medical Association 286(22):2866-6, 2001.

Baker M, Bell L, Avner J. The efficacy of routine outpatient management without antibiotics of fever in selected infants. Pediatrics 103:627-31, 1999.

Balas EA, Weingarten S, Garb CT, et al. Improving preventive care by prompting physicians. Archives of Internal Medicine 160(3):301-8, 2000.

Balas EA. Information systems can prevent errors and improve quality. Journal of the American Medical Informatics Association 8:398-9, 2001.

Barach P, Kelly MJ. Medical errors and patient safety in Massachusetts: what is the role of the Commonwealth? Massachusetts Health Policy Forum (MHPF). Boston: MHPF, 2000.

Barach P, Moss F. Delivering safety health care: safety is a patient's right and the obligation of all health professionals. British Medical Journal 323:585-6, 2001.

Barach P, Small SD. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. British Medical Journal 320:759-63, 2000.

Barillo D, Cancio L, Kim S, et al. Fatal and near fatal complication of liposuction. Southern Medical Journal 91(5):487-92, 1998.

Barr K, Breindel C. Ambulatory care. In Wolper, L. (editor) Health Care Administration. Aspen Publishing. New York, 1999. pp. 431-67.

Batalden PB, Mohr JJ, Nelson EC, et al. Continually improving the health and value of health care for a population of patients: the panel management process. Quality Management in Health Care 5(3):41-51, 1997.

Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. Journal of the American Medical Association 280(15):1311-6, 1998.

Bates DW. Using information technology to reduce rates of medication errors in hospitals. British Medical Journal 320:788-91, 18 March 2000.

Bates DW, Gawande A. Error in medicine: what have we learned? Annals of Internal Medicine 132(9):763-7, 2001.

Bates DW, Cohen M, Leape LL, et al. Reducing the frequency of errors in medicine using information technology. Journal of the American Medical Informatics Association 8:299-308, 2001.

Bates DW, Teich JM, Lee J. The impact of physician order entry on medication error prevention. Journal of the American Medical Informatics Association 6:13-21, 1999.

Battles JB, Kaplan HS, Van der Schaaf TW, et al. The attributes of medical event-reporting systems: experience with a prototype medical event-reporting system for transfusion medicine. Archives of Pathology and Laboratory Medicine 122(3):231-3, 1998.

Becher EC, Chassin MR. Improving quality, minimizing error: making it happen. Health Affairs 20(3):68-81, 2001.

Benedict GS. Chapter 2, Forces driving physicians into medical groups, and Chapter 3, Benefits of medical groups for physicians. The Development and Management of Medical Groups. Englewood, CO: Medical Group Management Association and Chicago, IL, American Medical Association, 1996.

Berwick DM, Leape LL. Reducing errors in medicine. British Medical Journal 319(7203):136, 1999.

Berwick DM. Not again! British Medical Journal 322(7281):247-8, 2001.

Billings CE. Some hopes and concerns regarding medical event-reporting systems: lessons from the NASA Aviation Safety Reporting System. Archives of Pathology and Laboratory Medicine 122(3):214-5, 1998.

Birkmeyer JD, Birkmeyer CM, Wennberg DE, et al. Leapfrog patient safety standards: the potential benefits of universal adoption. The Leapfrog Group, November 2000.

Bogardus S, Holmboe E, Jekel J. Perils, pitfalls, and possibilities in talking about medical risks. Journal of the American Medical Association 281(11):1037-41, 1999.

Bovbjerg R. Medical malpractice: folklore, facts and the future. Annals of Internal Medicine 117(9):788-91, 1992.

Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. New England Journal of Medicine 324(6):370-6, 1991.

Brennan TA. Reporting of errors: how much should the public know? Effective Clinical Practice 3(6):298-9, 2001.

Briefings on Patient Safety. Reporting medical errors poses many challenges for ambulatory facilities. Pp. 8-11, September 2001.

Buck ML. Preventing medication errors in children. Pediatric Pharmacotherapy 5(10):1-4, 1999.

Burstin H, Lipsitz S, Brennan T. Socioeconomic status and risk for substandard medical care. Journal of the American Medical Association 268(17):2383-7, 1992.

Chassin MR, Galvin RW, and the National Roundtable on Health Care Quality. The urgent need to improve health care quality. Journal of the American Medical Association 280(11):1000-5, 1998.

Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesthesia Analog 89(6):1352-9, 1999.

Classen DC, Pestotnik SL, Evans RS, et al. Computerized surveillance of adverse drug events in hospital patients. Journal of the American Medical Association 266:2847-51, 1991.

Classen DC, Pestotnik SL, Evans RS, et al. Description of a computerized adverse drug event monitor using a hospital information system. Hospital Pharmacy 27(9):774,776-7,783, 1992.

Classen DC, Pestotnik SL, Evans RS, et al.. Adverse drug events in hospitalized patients: excess length of stay, extra costs, and attributable mortality. Journal of the American Medical Association 277(4):301-6, 1997.

Classen DC. Clinical decision support systems to improve clinical practice and quality of care. Journal of the American Medical Association 280(15):1360-1,21, 1998.

Clemmer TP, Spuhler VJ, Oniki TA, et al. Results of a collaborative quality improvement program on outcomes and costs in a tertiary critical care unit. Critical Care Medicine 27(9):1768-74, 1999.

Cohen MR. Why error reporting systems should be voluntary. British Medical Journal 320:728-9, 18 March 2000.

Coleman W, Hanke C, Lillis P, et al. Does the location of the surgery or specialty of the physician affect malpractice claims in liposuction? Dermatological Surgery, 25(5):343-7, 1999.

Cook RI, Render M, Woods DD. Gaps in the continuity of care and progress on patient safety. British Medical Journal 320:791-4, 2000.

Cooper RA, Laud P, Dietrich CL. Current and projected workforce of nonphysician clinicians. Journal of the American Medical Association 280(9):680-7, 1998.

Cullen DJ, Bates DW, Leape LL, et al. Prevention of adverse drug events: a decade of progress in patient safety. Journal of Clinical Anesthesiology 12(8):600-14, 2000.

Davis J. Ambulatory surgery: how far can we go? Medical Clinics of North America 77(2):365-75, 1993.

Davis RM, Wagner EH, Groves T. Advances in managing chronic disease. British Medical Journal 320(7234):525-6, 2000.

Delaney DC, Fitzmaurice DA, Riaz A, et al. Can computerized decision support systems deliver improved quality in primary care? British Medical Journal 319:1-3, 1999.

Dexter PR, Perkins S, Overhage JM, et al. A computerized reminder system to increase the use of preventive care for hospitalized patients. New England Journal of Medicine 345(13):965-70, 2001.

Deyo RA. A key medical decision maker: the patient. British Medical Journal 323(Sept 1):466-7, 2001.

The Writing Group. Conducting the direct observation of primary care study. Journal of Family Practice 50(4):345-52, 2001.

Duffy SQ, Farley DE. Patterns of decline among inpatient procedures. Public Health Reports 110(6): 674-81, 1995.

Escarce J, Chen W, Schwartz J. Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy. Journal of the American Medical Association 273:1581-5, 1995.

Evans RS, Classen DC, Pestotnik SL,et al. Improving empiric antibiotic selection using computer decision support. Archives of Internal Medicine 154(8):878-84, 1994.

Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. New England Journal of Medicine 338(4):232-8, 1998.

Evans RS, Pestotnik SL, Classen DC, et al. Evaluation of a computer-assisted antibiotic-dose monitor. Annals of Pharmacotherapy 33(10):1026-31, 1999.

Ferguson T. Digital doctoring-opportunities and challenges in electronic patient-physician communication. Journal of the American Medical Association 280(15):1361-2, 1998.

Field TS, Gurwitz JH, Avorn J, et al. Risk factors for adverse drug events among nursing home residents. Archives of Internal Medicine 161(13):1629-34, 2001.

Fischer G, Fetters MD, Munro AP, et al. Adverse events in primary care identified from a risk management database. Journal of Family Practice 45(1):40-6, 1997.

Fitzgerald, M. The midlevel provider: colleague or competitor? Patient Care 29(1):1996.

Flowers L, Riley T. State-based Mandatory Reporting of Medical Errors: An Analysis of the Legal and Policy Issues. Portland, ME, National Academy for State Health Policy, March 2001.

Forkner-Dunn DJ. Commentary: to err is human—but not in health care. American Journal of Medical Quality 15(6):263-6, 2000.

Fraser SW, Greenhalgh T. Coping with complexity: educating for capability. British Medical Journal 323:799-803, 2001.

Gaba DM. Human error in dynamic medical domains. Chapter 11 (pp. 197-224) in Human Error in Medicine. Bogner MS, editor. Hillsdale, NJ: Lawrence Erlbaum and Associates, 1994.

Gaba DM. Anaesthesiology as a model for patient safety in health care. British Journal of Medicine 320:785-8, 2000.

Gandhi T, Burstin H, Cook E. Drug complications in outpatients, Journal of General Internal Medicine 15(3):149-54, 2000a.

Gandhi T, Puopolo A, Dasse P, et al. Obstacles to collaborative quality improvement: the case of ambulatory general medical care. International Journal of Quality in Health Care 12(1):115-23, 2000b.

Gandhi TK, Seger DL, Bates DW. Identifying drug safety issues: from research to practice. International Journal of Quality in Health Care 12(2):69-76, 2000c.

Gandhi TK, Weingart SN, Seger DS, et al. Medication errors and adverse drug events in the ambulatory setting. Journal of General Internal Medicine 16(supplement 1, April):133, 2001a (abstract).

Gandhi TK, Weingart SN, Seger DS, et al. Impact of basic computerized prescribing on outpatient medication errors and adverse drug events. Journal of General Internal Medicine 16(supplement 1, April):195, 2001b (abstract).

Gans DN. Just how good were the good old days? MGMA Connexion, pp.30-1, October 2001.

Garr DR, Marsh FJ. Medical malpractice and the primary care physician: lowering the risks. Southern Medical Journal 79:1280-4, 1986.

Gawande AA, Bates DW. The use of information technology in improving medical performance. Part II. Physician-support tools. MedGenMed February 14:E13, 2000.

Gelissen RHM. Incident Reporting Systems in the Medical Field: An Inventory Using the NMMS Framework. Unpublished doctoral thesis, Eindhoven University of Technology. Thesis supervisor: Dr. T.W. van der Schaaf, Eindhoven University of Technology, Safety Management Group.1997.

Glauber J, Homer CJ, Berwick DM. Reducing medical error through systems improvement: the management of febrile infants. Pediatrics, 105(6):1330-2, 2000.

Goldberg HI, Neighbor WE, Cheadle AD, et al. A controlled time-series trial of clinical reminders: Using computerized firm systems to make quality improvement research a routine part of mainstream practice. Health Services Research 34(7):1519-34, 2000.

Greely, HT. Do Physicians have a duty to disclose? Western Journal of Medicine 171:82-3, 1999.

Green LA, Dovey SM. Practice based primary care research networks: they work and are ready for full development and support. British Medical Journal 322:567-8, 2001.

Gurwitz JH, Sanchez-Cross MT, Eckler MA, et al. The epidemiology of adverse and unexpected events in the long-term care setting. Journal of the American Geriatric Society 42(1):33-8, 1994.

Gurwitz JH, Field TS, Avorn , et al. Incidence and preventability of adverse drug events in nursing homes. American Journal of Medicine 109(2):87-94, 2000.

Haas JS, Cook EF, Puopolo AL, et al. Differences in quality of care for women with abnormal mammogram or clinical breast complaints. Journal of General Internal Medicine 15:321-8, 2000.

Hackman JR (editor). Groups That Work And Those That Don't: Creating Conditions for Effective Teamwork. Jossey-Bass, 1990.

Hall M, Lawrence L. Ambulatory surgery in the United States. Vital Health Statistics 300:1-16, 1998.

Hanlon JT, Schmader KE, Koronkowski JM, et al. Adverse drug events in high risk older outpatients. Journal of the American Geriatric Society 45(8):945-8, 1998.

Hanlon JT, Schmader KE, Ruby CM, et al. Suboptimal prescribing in older inpatients and outpatients. Journal of the American Geriatric Society 49(2):200-9, 2001.

Harbrecht M, Thomasson G, Quinn R, et al. Conference to Develop a Research Agenda for Ambulatory Patient Safety: Summary from Copic Insurance Company. Copic Insurance Company, Denver, CO. November 2000.

Hatlie MJ. Thoughts on the future of the patient safety movement. Chapter, American College of Surgeons Patient Safety Manual, 4th ed. American College of Surgeons, Chicago, IL, publication pending.

Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. Journal of the American Medical Association 286(4):415-20, 2001.

Heinrich HW. Industrial Accident Prevention: A Scientific Approach. New York and London, 1941.

Helmreich RL. On error management: lessons from aviation. British Medical Journal 320:781-5, 18 March 2000.

Helmreich RL and Schaefer, H. Team performance in the operating room. Chapter 12 (pp. 225-253) in Human Error in Medicine. Bogner MS, editor. Hillsdale, NJ: Lawrence Erlbaum and Associates, 1994.

Helmreich RL, Musson DM, Sexton B. Applying aviation safety initiatives to medicine. Focus on Patient Safety 4(1):1-2, 2001, National Patient Safety Foundation.

Hess AMR, Nelson EC, Johnson DJ, et al. Building an idealized measurement system to improve clinical office practice performance. Managed Care Quarterly 7(3):22-34, 1999.

Hofer TP, Kerr EA, Hayward RA. What is an error? Effective Clinical Practice 3(6):261-9, 2000.

Holman H, Lorig, K. Patients as partners in managing chronic disease: Partnership is a prerequisite for effective and efficient health care. British Medical Journal 320(7234):526-7, 2000.

Honigman B, Lee J, Rothschild J, et al. Using computerized data to identify adverse drug events in outpatients. Journal of the American Medical Informatics Association 8(3):254-66, 2001a.

Honigman B, Light P, Pulling RM, et al. A computerized method for identifying incidents associated with adverse drug events in outpatients. International Journal of Medical Informatics 61(1):21-32, 2001b.

Hunt DL, Haynes RB, Hanna SE, et al. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. Journal of the American Medical Association 280(15):1339-46, 1998.

Institute for Healthcare Improvement. Idealized design of clinical office practices. http://www.IHI.org/idealized/idcop. August 2001

Institute of Medicine, Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, eds. Washington, D.C: National Academy Press, 1999.

Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy of Sciences, 2001.

James BC. Making it easy to do right. New England Journal of Medicine 345(13):991-3, 2001.

Jencks SF, Cuerdon T, Burwen DR, et al. Quality of medical care delivered to Medicare beneficiaries: a profile at State and national levels. Journal of the American Medical Association 284(13):1670-6, 2000.

Jencks S. Public reporting of serious medical errors. Effective Clinical Practice 3(6):299-301, 2001.

Jha AK, Kuperman GJ, Teich JM, et al. Identifying adverse drug events: development of a computer-based monitor and comparison to chart review and stimulated voluntary report. Journal of the American Medical Informatics Association 5:305-14, 1998.

Jha AK, Kuperman GJ, Rittenberg E, et al. Identifying hospital admissions due to adverse drug events using a computer-based monitor. Pharmacoepidemiology and Drug Safety 10(2):113-9, 2001.

Johnson J, Bootman J. Drug related morbidity, mortality and the economic impact of pharmaceutical care. American Journal Health System Pharmacology 54: 554-8, 1997.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Revisions to Joint Commission Standards in Support of Patient Safety and Medical/Health Care Error Reduction, Effective July 1, 2001. JCAHO, Oakbrook Terrace, IL, 2001.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Kernicterus threatens healthy newborns. Sentinel Event Alert. JCAHO, Oakbrook Terrace, IL. Online at http://www.jcaho.org/ptsafety_frm.html, April 2001.

Kaplan HS, Battles JB, Van der Schaaf TW, et al. Identification and classification of the causes of events in transfusion medicine. Transfusion 38(11-12):999-1003, 1998.

Karson AS, Bates DW. Screening for adverse events. Journal of Evaluation in Clinical Practice 5(1):1-4, 1999.

Katzenbach JR, Smith DK. The Wisdom of Teams: Creating the High-Performance Organization, Harper Collins, New York, 1993.

Kaushal R, Barker KN, Bates DW. How can information technology improve patient safety and reduce medication errors in children's health care? Archives of Pediatrics and Adolescent Medicine 155(9):1002-7, 2001.

Kilo C, Berwick D. Interview with Chuck Kilo and Don Berwick of the Institute for Healthcare Improvement. Managed Care Quarterly 7(3):1-4, 1999.

Kovner AR, Elton JJ, Billings J. Evidence-based management. Frontiers of Health Services Management 16(4):3-24, 2000.

Kowalczyk L. With costs up, HMOs to monitor patients: Blue Cross-Blue Shield, Tufts OK claim analysis. Boston Globe, April 8, 2001.

Kozak L, McCarthy E, Pokras R. Changing patterns of surgical care in the United States 1980-1995. Health Care Financing Review 21(1):31-49, 1999.

Kraman SS, Hamm G. Risk management: extreme honesty may be the best policy. Annals of Internal Medicine 131.12:963-7, 1999.

Kravitz R, Rolph J Peterson L. Claims and the limits of defensive medicine. Medical Care Research and Review 54(4):456-71, 1997.

Leape L. Error in Medicine. Journal of the American Medical Association 272(23):1851-7, 1994.

Leape LL. Institute of Medicine medical error figures are not exaggerated. Journal of the American Medical Association 284(1):95-7, 2000.

Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. Journal of the American Medical Association 274(1):35-43, 1995.

Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. Journal of the American Medical Association 282(3):267-70, 1999.

Leape LL, Kabcenell AI, Gandhi TK, et al. Reducing adverse drug events: lessons from a breakthrough series collaborative. Joint Commission Journal on Quality Improvement 26(6):321-31, 2000.

Leapfrog Group. Leapfrog initiatives to drive great leaps in patient safety. Online at http://www.leapfroggroup.org/safety1.htm and http://www.leapfroggroup.org/safety2.htm. December 2000.

Luft HS, Greenlick MR. The contribution of group- and staff-model HMOs to American medicine. The Milbank Quarterly 74(4):445-67, 1996.

McDonald CJ, Overhage M, Dexter PR, et al. Canopy computing: using the Web in clinical practice. Journal of the American Medical Association 280(15):1325-9, 1998.

McDonald C, Weiner M., and Hui S. Deaths due to medical errors are exaggerated in Institute of Medicine report. Journal of the American Medical Association 284(1):93-5, 2000.

Macklis RM, Meier T, Weinhous MS. Error rates in clinical radiotherapy. Journal of Clinical Oncology 16:551-6, 1998.

Malpass A, Helps SC, Runciman WB. An analysis of Australian adverse drug events. Journal of Quality in Clinical Practice 19(1):27-30, 1999.

Medical Group Management Association. Cost Survey—for the years 1995, 1996, 1997, 1998, 1999, 2000. Englewood, Colorado: Medical Group Management Association.

Medical Group Management Association. Physician Compensation and Production Survey—for the years 1995, 1996, 1997, 1998, 1999, 2000. Englewood, Colorado: Medical Group Management Association.

Messinger SF, Welters TL. The value of the group practice model: results from a comprehensive survey. Group Practice Journal February:11-16, 2001.

Mezei G. and Chung F. Return hospital visits and hospital readmission after ambulatory surgery. Annals of Surgery 230(5):721-7, 1999.

Return to Contents
Proceed to Next Section

Current as of December 2001
Internet Citation: Section 7: An Agenda for Research in Ambulatory Patient Safety. December 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/other/ptsafety/references.html