Health care-related harm is an internationally recognized threat to public health. The United Kingdom’s national health services demonstrate that upwards of 90% of health care encounters can be delivered in ambulatory settings. Other countries are transitioning to more family practice-based health care systems, and efforts to understand avoidable harm in these settings is needed. We developed 100 scenarios reflecting a range of diseases and informed by the World Health Organization definition of ‘significant harm’. Scenarios included different types of patient safety incidents occurring by commission and omission, demonstrated variation in timeliness of intervention, and conditions where evidence-based guidelines are available or absent. We conducted a two-round RAND / UCLA Appropriateness Method consensus study with a panel of family practitioners in England to define “avoidable harm” within family practice. Panelists rated their perceptions of avoidability for each scenario. We ran a k-means cluster analysis of avoidability ratings. Panelists reached consensus for 95 out of 100 scenarios. The panel agreed avoidable harm occurs when a patient safety incident could have been probably, or totally, avoided by the timely intervention of a health care professional in family practice (e.g. investigations, treatment) and / or an administrative process (e.g. referrals, alerts in electronic health records, procedures for following up results) in accordance with accepted evidence-based practice and clinical governance. Fifty-four scenarios were deemed avoidable, whilst 31 scenarios were rated unavoidable and reflected outcomes deemed inevitable regardless of family practice intervention. Scenarios with low avoidability ratings (1 s or 2 s) were not represented by the categories that were used to generate scenarios, whereas scenarios with high avoidability ratings (7 s 8 s or 9 s) were represented by these a priori categories. The findings from this RAND/UCLA Appropriateness Method study define the characteristics and conditions that can be used to standardize measurement of outcomes for primary care patient safety. We have developed a definition of avoidable harm that has potential for researchers and practitioners to apply across primary care settings, and bolster international efforts to design interventions to target avoidable patient safety incidents that cause the most significant harm to patients.

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识别家庭实践中的“可避免的危害”：RAND / UCLA适当方法共识研究

与卫生保健有关的危害是国际公认的对公共卫生的威胁。英国的国家卫生服务表明，可以在非卧床环境中提供90％以上的卫生保健服务。其他国家正在过渡到更多基于家庭实践的医疗保健系统，因此需要努力了解这些环境中可避免的危害。我们根据世界卫生组织对“重大伤害”的定义，开发了100种反映多种疾病的情景。场景包括因委托和疏忽而发生的不同类型的患者安全事件，干预及时性的变化以及存在或缺乏循证指南的情况。我们与英格兰的家庭医生小组进行了两轮的RAND / UCLA适当性方法共识研究，以定义家庭实践中的“可避免的伤害”。小组成员对每种情况下他们对可避免性的看法进行了评分。我们对可避免性等级进行了k均值聚类分析。在100个场景中，有95个小组成员达成了共识。专家组商定，当医护专业人员及时干预家庭实践（例如，调查，治疗）和/或行政程序（例如，转诊，戒烟警报）时，可能已经或完全避免了患者安全事件时，就会发生可避免的伤害。电子健康记录，结果追踪程序），并应遵循公认的循证医学实践和临床管理。有54种情况被认为是可以避免的，31种情况被认为是不可避免的，无论家庭干预如何，反映出的结果都被认为是不可避免的。具有较低可避免性等级（1 s或2 s）的方案未由用于生成方案的类别表示，而具有较高可避免性等级（7 s 8 s或9 s）的方案由这些先验类别表示。这项RAND / UCLA适当性方法研究的发现确定了可用于标准化对初级保健患者安全性结果测量的特征和条件。我们已经制定了可避免伤害的定义，对于研究人员和从业人员来说，它有可能在初级保健环境中应用，并加强国际努力来设计干预措施，以针对可对患者造成最大伤害的可避免患者安全事件为目标。