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October 8, 2003

Looking for Medical Injuries Where the Light Is Bright

Author Affiliations

Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Mass.

JAMA. 2003;290(14):1917-1919. doi:10.1001/jama.290.14.1917

Health care quality improvement experts often argue that "you can't manage what you can't measure." Suitable yardsticks are essential to judge the magnitude of potential quality problems and track whether interventions improve care. However, this aphorism needs one critical addendum: "You can't measure what you can't define."

Measurement and definitional issues loom large when discussing patient safety. The bellwether 1999 Institute of Medicine report To Err Is Human provided compelling evidence that medical errors pose daily risks throughout the US health care system but failed to quash controversy about the magnitude of that risk.1 The best-known estimates of the extent of medical error rely on extrapolations from medical record review studies,2,3 although these numbers have generated heated debate.4-6