Putting adverse drug events into perspective.

We have become all too familiar with the dark side of the industrial model of medicine in which physicians become vendors, patients are covered lives generating revenue streams, and providing care for the sick is described in terms of "medical loss ratios." However, the 3 articles in this issue ofJAMAthat deal with the prevention of adverse drug events (ADEs)1-3illustrate that a "systems" approach to thinking about health care services can also be used for nobler purposes. See also pp 301, 307, and 312. Traditionally, hospital care has been seen as a series of separate and unrelated interactions between health care professionals and individual patients. Viewed from the perspective of the physician (as things once were), "the health care professional" was usually the doctor, with the importance of other actors such as nurses and pharmacists rarely appreciated. The industrial vision of medicine has brought with it, along

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[2]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[3]  D S Stein,et al.  Factors related to errors in medication prescribing. , 1997, JAMA.

[4]  R. Brook,et al.  The effect of alternative case-mix adjustments on mortality differences between municipal and voluntary hospitals in New York City. , 1994, Health services research.

[5]  H L Lipton,et al.  Drug Utilization Review in Ambulatory Settings: State of the Science and Directions for Outcomes Research , 1993, Medical care.

[6]  L I Iezzoni,et al.  Judging hospitals by severity-adjusted mortality rates: the influence of the severity-adjustment method. , 1996, American journal of public health.

[7]  D. Classen,et al.  Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. , 1997, JAMA.

[8]  D. Bates,et al.  The Costs of Adverse Drug Events in Hospitalized Patients , 1997 .

[9]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[10]  R H Brook,et al.  Explaining variations in hospital death rates. Randomness, severity of illness, quality of care. , 1990, JAMA.

[11]  N. Dickey,et al.  Systems analysis of adverse drug events. , 1996, JAMA.

[12]  S R Salem-Schatz,et al.  A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. , 1992, The New England journal of medicine.

[13]  D M Berwick,et al.  Continuous improvement as an ideal in health care. , 1989, The New England journal of medicine.