Helping Science Keep Pace With Policy
نویسنده
چکیده
FOUR YEARS AFTER SORREL KING’S DAUGHTER, JOSIE, DIED from preventable medical errors in 2001, King asked us if her daughter would be less likely to die today. We answered by describing the myriad safety programs in hospitals. She abruptly cut us off. King was not interested in what we were doing. She wanted evidence that Josie and other patients were less likely to be harmed by medical care today, but we could not give her this evidence. A decade after the To Err Is Human report, the global health care community still struggles to state definitively whether patients are safer. Despite rhetoric and work to improve safety, sufficient effort to rigorously evaluate patients has not happened. The general public, US Congress, and health care payers demand public accountability and safer outcomes. Given the desire to measure safety outcomes, why has it been so challenging? The main barrier has been poor investment in the basic science of patient safety. Basic science would allow better understanding of the causes of harm, help in designing and pilot testing interventions to reduce harm, and then robustly evaluate the effects of harm. Great feats such as the sequencing of the human genome and the observation of the blood flow and cell function in the brain have been accomplished. Surely measures of patient safety can be developed. Most investment and interest in patient safety has been reactive and politically motivated to address egregious, although relatively rare, examples of preventable harm, such as operating on the wrong body part. Other types of preventable harm are more common yet more nuanced. Yet, a dollar is spent on basic and clinical research for every penny spent to ensure patient safety. Without a strong science base, valid and transparent measurement, leadership and accountability, and tenacious political visibility, well-intentioned health systems will continue their struggle to improve patient safety. Most expenditure for patient safety will be neither effective nor efficient. Central to making progress is the ability to distinguish preventable harm from inevitable harm. In this Commentary, we review strategies to make this distinction, discuss several risks with alternative approaches, and offer suggestions for progress in answering—are patients safer?
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تاریخ انتشار 2009