Apparent backfires in quality improvement—worsening what the intervention aimed to improve
| Web-based software allowing health professionals in general practices to view individual patients’ scores summarising their risk of needing emergency admission significantly increased emergency hospital admissions and use of other NHS services.1 | Probably a combination of having an unfamiliar risk highlighted, inadequate management strategies for certain types of risk and appropriate identification of situations better managed in hospital |
| Providing intensive primary care to recently hospitalised chronically ill veterans increased rehospitalisations.38 | Probably a combination of lack of familiarity with managing patient population enriched in complexity and appropriate identification of situations better managed in hospital |
| Home-based medication review by pharmacists for recently discharged older patients increased hospital readmission rates.35 | Probably a combination of exposing clinicians to risks in an unfamiliar setting (patients’ homes) and appropriate identification of situations better managed in hospital |
| New device for earlier detection of heart failure exacerbations ended up increasing hospitalisations and outpatient visits.58 | Lack of familiarity with this new type of information about a worrisome condition likely resulted in clinicians erring on the side of caution. |
NHS, National Health Service.