Understanding the epidemiology of avoidable significant harm in primary care

Protocol for a retrospective cross-sectional study

Brian G. Bell, Stephen Campbell, Andrew Carson-Stevens, Huw Prosser Evans, Alison Cooper, Christina Sheehan, Sarah Rodgers, Christine Johnson, Adrian Edwards, Sarah Armstrong, Rajnikant Mehta, Antony Chuter, Ailsa Donnelly, Darren M. Ashcroft, Joanne Lymn, Pam Smith, Aziz Sheikh, Matthew Boyd, Anthony J. Avery

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    Abstract

    Introduction: Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and analysis: We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to 16 general practices from 3 areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100 000 patients. Our investigations will include an 'enhanced sample' of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as 'per 100 000 patients per year'. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination: The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included, we will follow these instructions. We will produce a report for the Department of Health's Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act 2006 (reference 15/CAG/0182).

    Original languageEnglish
    Article numbere013786
    Pages (from-to)1-8
    Number of pages8
    JournalBMJ Open
    Volume7
    Issue number2
    DOIs
    Publication statusPublished - 1 Feb 2017

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    Primary Health Care
    Epidemiology
    Cross-Sectional Studies
    General Practice
    Medical Errors
    Research Ethics Committees
    Confidentiality
    Computer Systems
    Patient Safety
    Health Policy
    Research
    Ethics
    England
    Medical Records
    Publications
    Multivariate Analysis
    Incidence

    Cite this

    Bell, B. G., Campbell, S., Carson-Stevens, A., Evans, H. P., Cooper, A., Sheehan, C., ... Avery, A. J. (2017). Understanding the epidemiology of avoidable significant harm in primary care: Protocol for a retrospective cross-sectional study. BMJ Open, 7(2), 1-8. [e013786]. https://doi.org/10.1136/bmjopen-2016-013786
    Bell, Brian G. ; Campbell, Stephen ; Carson-Stevens, Andrew ; Evans, Huw Prosser ; Cooper, Alison ; Sheehan, Christina ; Rodgers, Sarah ; Johnson, Christine ; Edwards, Adrian ; Armstrong, Sarah ; Mehta, Rajnikant ; Chuter, Antony ; Donnelly, Ailsa ; Ashcroft, Darren M. ; Lymn, Joanne ; Smith, Pam ; Sheikh, Aziz ; Boyd, Matthew ; Avery, Anthony J. / Understanding the epidemiology of avoidable significant harm in primary care : Protocol for a retrospective cross-sectional study. In: BMJ Open. 2017 ; Vol. 7, No. 2. pp. 1-8.
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    abstract = "Introduction: Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and analysis: We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to 16 general practices from 3 areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100 000 patients. Our investigations will include an 'enhanced sample' of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as 'per 100 000 patients per year'. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination: The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included, we will follow these instructions. We will produce a report for the Department of Health's Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act 2006 (reference 15/CAG/0182).",
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    Bell, BG, Campbell, S, Carson-Stevens, A, Evans, HP, Cooper, A, Sheehan, C, Rodgers, S, Johnson, C, Edwards, A, Armstrong, S, Mehta, R, Chuter, A, Donnelly, A, Ashcroft, DM, Lymn, J, Smith, P, Sheikh, A, Boyd, M & Avery, AJ 2017, 'Understanding the epidemiology of avoidable significant harm in primary care: Protocol for a retrospective cross-sectional study', BMJ Open, vol. 7, no. 2, e013786, pp. 1-8. https://doi.org/10.1136/bmjopen-2016-013786

    Understanding the epidemiology of avoidable significant harm in primary care : Protocol for a retrospective cross-sectional study. / Bell, Brian G.; Campbell, Stephen; Carson-Stevens, Andrew; Evans, Huw Prosser; Cooper, Alison; Sheehan, Christina; Rodgers, Sarah; Johnson, Christine; Edwards, Adrian; Armstrong, Sarah; Mehta, Rajnikant; Chuter, Antony; Donnelly, Ailsa; Ashcroft, Darren M.; Lymn, Joanne; Smith, Pam; Sheikh, Aziz; Boyd, Matthew; Avery, Anthony J.

    In: BMJ Open, Vol. 7, No. 2, e013786, 01.02.2017, p. 1-8.

    Research output: Contribution to journalArticle

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    T1 - Understanding the epidemiology of avoidable significant harm in primary care

    T2 - Protocol for a retrospective cross-sectional study

    AU - Bell, Brian G.

    AU - Campbell, Stephen

    AU - Carson-Stevens, Andrew

    AU - Evans, Huw Prosser

    AU - Cooper, Alison

    AU - Sheehan, Christina

    AU - Rodgers, Sarah

    AU - Johnson, Christine

    AU - Edwards, Adrian

    AU - Armstrong, Sarah

    AU - Mehta, Rajnikant

    AU - Chuter, Antony

    AU - Donnelly, Ailsa

    AU - Ashcroft, Darren M.

    AU - Lymn, Joanne

    AU - Smith, Pam

    AU - Sheikh, Aziz

    AU - Boyd, Matthew

    AU - Avery, Anthony J.

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    KW - Humans

    KW - Incidence

    KW - Medical Errors/classification

    KW - Patient Safety/statistics & numerical data

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    KW - Retrospective Studies

    KW - Risk Factors

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