Identifying 'avoidable harm' in family practice: a RAND/UCLA Appropriateness Method consensus study.

Area of Science:

• Patient Safety
• Primary Care Medicine
• Health Services Research

Background:

• Health care-related harm is a significant global public health concern.
• Ambulatory and family practice settings now deliver over 90% of health care encounters in the UK.
• There is a growing need to understand and mitigate avoidable harm within primary care.

Purpose of the Study:

• To develop a consensus-based definition of "avoidable harm" specific to family practice settings.
• To establish criteria for identifying patient safety incidents that could have been prevented.
• To inform the standardization of outcome measurements in primary care patient safety.

Main Methods:

• A two-round RAND / UCLA Appropriateness Method consensus study was conducted with English family practitioners.
• 100 diverse patient safety scenarios were developed, informed by the World Health Organization's definition of significant harm.
• Panelists rated the avoidability of each scenario, followed by k-means cluster analysis of the ratings.

Main Results:

• Consensus was reached on 95 out of 100 scenarios.
• Avoidable harm was defined as patient safety incidents preventable by timely health care professional or administrative intervention, aligned with evidence-based practice.
• 54 scenarios were classified as avoidable, while 31 were deemed unavoidable outcomes.

Conclusions:

• A standardized definition of avoidable harm in primary care has been established.
• This definition can guide researchers and practitioners in measuring patient safety outcomes.
• The findings support the development of targeted interventions to reduce significant avoidable harm in primary care settings.