The reliability of medical record review for estimating adverse event rates.
BACKGROUND
The data used by the U.S. Institute of Medicine to estimate deaths from medical errors come from a study that relied on nurse and physician reviews of medical records to detect the errors.


OBJECTIVE
To measure the reliability of medical record review for detecting adverse events and negligent adverse events.


METHODS
Medical record review.


METHODS
Hospitalizations in Utah and Colorado in 1992.


METHODS
After three independent reviews of 500 medical records, the following were measured: reliability and the effect of varying criteria for reviewer confidence in and reviewer agreement about the presence of adverse events.


RESULTS
For agreements in judgments of adverse events among the three sets of reviews, the kappa statistics ranged from 0.40 to 0.41 (95% CIs ranged from 0.30 to 0.51) for adverse events and from 0.19 to 0.23 (CIs, 0.05 to 0.37) for negligent adverse events. Rates for adverse events and for negligent adverse events varied substantially depending on the degree of agreement and the level of confidence that was required among reviewers.


CONCLUSIONS
Estimates of adverse event rates from medical record review, including those reported by the Institute of Medicine in its 2000 report on medical errors, are highly sensitive to the degree of consensus and confidence among reviewers.
Thomas
Eric J
EJ
Brigham and Women's Hospital and Harvard School of Public Health, Harvard University, Boston, Massachusetts 02115, USA.
Lipsitz
Stuart R
SR
Studdert
David M
DM
Brennan
Troyen A
TA
D003120:Colorado; D015340:Epidemiologic Research Design; D006761:Hospitals; D006801:Humans; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data*; D008499:Medical Records / Q000592:standards*; D015203:Reproducibility of Results; D014589:Utah