To the Editor.
—The article by Brennan et al,1 "Hospital Characteristics Associated With Adverse Events and Substandard Care," suggested an approach to measuring quality of care in hospitals that may indeed be an important improvement on existing methods. Their findings demonstrated consequential differences in the occurrence of AEs and AEs associated with negligence in primary teaching hospitals and among minority patients, as compared with other subjects. The care of patients in primary teaching hospitals and hospitals that care for minority patients is heavily dependent on house staff, and this important factor, a vital variable in evaluating quality of care, was not considered in their study.The findings and the recommendations of the New York State Committee,2 which I chaired, led to state regulations limiting the working hours of residents but, of much greater importance, led to the setting of new rules, which attempt to improve the supervision of
Bell BM. Hospital Events Associated With Adverse Events and Substandard Care. JAMA. 1991;266(21):2983-2984. doi:10.1001/jama.1991.03470210051019