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December 4, 1991

Hospital Events Associated With Adverse Events and Substandard Care

Author Affiliations

Grays Knob, Ky

Grays Knob, Ky

JAMA. 1991;266(21):2983. doi:10.1001/jama.1991.03470210051017

To the Editor.  — I do not agree that the observations by Brennan et al1 "may represent an important improvement on existing measures of quality," ie, outcome-based measures. My disagreement can be understood by considering a hypothetical premise that illustrates a significant potential bias in the article by Brennan et al.My premise is that academic physician specialists are uncomfortable with outcome-based measures of quality of care because this puts them on equal footing with nonacademic physicians. Further, they prefer the concept of negligence-based quality assurance because this enables academic-based reviewers to insert a subtle bias in favor of teaching hospitals.In the article by Brennan et al, a group of academic-based reviewers (or, at least, physician reviewers selected by academic-based reviewers and likely to be sympathetic to them) reviewed charts of about 50 hospitals. The reviewers were likely to be personally familiar with some of these institutions, while