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Article
April 17, 1991

Effect of Outcome on Physician Judgments of Appropriateness of Care

Author Affiliations

From the Departments of Anesthesiology, Virginia Mason Medical Center (Dr Caplan) and University of Washington School of Medicine (Drs Posner and Cheney), Seattle. Dr Cheney is the chairman of the Committee on Professional Liability, American Society of Anesthesiologists.

From the Departments of Anesthesiology, Virginia Mason Medical Center (Dr Caplan) and University of Washington School of Medicine (Drs Posner and Cheney), Seattle. Dr Cheney is the chairman of the Committee on Professional Liability, American Society of Anesthesiologists.

JAMA. 1991;265(15):1957-1960. doi:10.1001/jama.1991.03460150061024
Abstract

Is a permanent injury more likely to elicit a rating of inappropriate care than a temporary injury? To explore this question, we asked 112 practicing anesthesiologists to judge the appropriateness of care in 21 cases involving adverse anesthetic outcomes. The original outcome in each case was classified as either temporary or permanent. The authors then generated a matching alternate case identical to the original in every respect except that a plausible outcome of opposite severity was substituted. The original and alternate cases were randomly divided into two sets and assigned to reviewers who were blind to the intent of the study. The reviewers were asked to rate independently the care in each case as appropriate, less than appropriate, or impossible to judge, based on their personal (implicit) judgment of reasonable and prudent practice. A significant inverse relationship between severity of outcome and judgments of appropriateness of care was observed in 15 (71%) of the 21 matched pairs of cases. Overall, the proportion of ratings for appropriate care decreased by 31 percentage points when the outcome was changed from temporary to permanent and increased by 28 percentage points when the outcome was changed from permanent to temporary. We conclude that knowledge of the severity of outcome can influence a reviewer's judgment of the appropriateness of care.

(JAMA. 1991;265:1957-1960)

References
1.
Cheney FW, Posner K, Caplan RA, Ward RJ.  Standard of care and anesthesia liability . JAMA. 1989;261:1599-1603.Article
2.
Caplan RA, Posner K, Ward RJ, Cheney FW.  Peer review of anesthetic mishaps: effect of severity of injury . Anesthesiology. 1988;69:A722.Article
3.
Posner KL, Sampson PD, Caplan RA, Ward RJ, Cheney FW.  Measuring interrater reliability among multiple raters: an example of methods for nominal data . Stat Med. 1990;9:1103-1115.Article
4.
Brunner EA.  The National Association of Insurance Commissioners' Closed Claim Study . Int Anesthesiol Clin. Summer 1984;22:17-30.Article
5.
Schneider AJL.  Assessment of risk factors and surgical outcome . Surg Clin North Am. 1983;63: 1113-1126.
6.
Edgington ES. Randomization Tests . New York, NY: Marcel Dekker Inc; 1987:34-35.
7.
Fleiss JL.  Measuring nominal scale agreement among many raters . Psychol Bull. 1971;76:378-382.Article
8.
Cohen J. Statistical Power Analysis for the Behavioral Sciences . Orlando, Fla: Academic Press Inc; 1987:215-271.
9.
Koran LM.  The reliability of clinical methods, data and judgments . N Engl J Med. 1975;293:642-646.Article
10.
Dubois RW, Brook RH.  Preventable deaths: who, how often, and why? Ann Intern Med. 1988;109:582-589.Article
11.
Brennan TA, Localio RJ, Laird NL.  Reliability and validity of judgments concerning adverse events suffered by hospitalized patients . Med Care. 1989;27:1148-1158.Article
12.
Leape LL.  Practice guidelines and standards: an overview . QRB. 1990;16:42-49.
13.
Lohr KN, Schroeder SA.  A strategy for quality assurance in Medicare . N Engl J Med. 1990;322: 707-712.Article
14.
Chassin MR, Kosecoff J, Park RE, et al.  Does inappropriate use explain geographic variations in the use of health care services? a study of three procedures . JAMA. 1987;258:2533-2537.Article
15.
Winslow CM, Solomon DH, Chassin MR, Kosecoff J, Merrick NJ, Brook RH.  The appropriateness of carotid endarterectomy . N Engl J Med. 1988;318:721-727.Article
16.
Brook RH, Appel FA.  Quality-of-care assessment: choosing a method for peer review . N Engl J Med. 1973;288:1323-1329.Article
17.
Nobrega FT, Morrow GW, Smoldt RK, Offord KP.  Quality assessment in hypertension: analysis of process and outcome methods. N Engl J Med. 1977;296:145-148.Article
18.
Fessel WJ, Van Brunt EE.  Assessing quality of care from the medical record . N Engl J Med. 1972;286:134-138.Article
19.
Brook RH.  Quality: can we measure it? N Engl J Med. 1977;296:170-172.Article
20.
Caplan RA, Posner KL, Ward RJ, Cheney FW.  Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology. 1990;72: 828-833.Article
21.
Kroll DA, Caplan RA, Posner K, Ward RJ, Cheney FW.  Nerve injury associated with anesthesia. Anesthesiology. 1990;73:202-207.Article
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