Rebecca N. Warburton

Improving patient safety: an economic perspective on the role of nurses.

AIMS This paper synthesises patient safety research and insights from economic theory to generate guidance for nurse managers. The paper describes the key roles nurses and nurse managers can play in improving patient safety, and explains how insights from health economics can help inform and enhance this role, helping nurse managers to set priorities for improvement and for future research. BACKGROUND Awareness of the need to improve patient safety is high, but insufficient attention has been paid to the cost-effectiveness of safety improvements, leading to difficulty in setting priorities. This paper suggests specific methods that nurses can and should use to prioritize and evaluate safety improvements. EVALUATION This is a review article, synthesising the results of research on patient safety. KEY ISSUES Because of their close connection to patients, nurses (and nurse managers in particular) have key roles to play in improving patient safety. Improving patient safety will also benefit nurses and other practitioners directly, because caregivers suffer lasting distress from being involved in incidents that harm patients. Reducing harmful incidents should also reduce attrition and alleviate chronic staffing shortages. Insights from health economics can help nurse managers to set priorities for improvement and to more effectively evaluate the changes made. CONCLUSIONS Evidence on the costs and effects of most safety improvements is still lacking. Nurses can and should take a leadership role in implementing changes and evaluating their costs and effects. IMPLICATIONS FOR NURSING MANAGEMENT To lead improvements in patient safety, nurse managers need to learn to use the Plan-Do-Study-Act Improvement Cycle, and need to develop an awareness of and ability to measure the costs and effects of changes. These changes would allow nurse managers to better make the business case for patient safety.

Canada Needs Better Data for Evidence-Based Policy: Inconsistencies Between Administrative and Survey Data on Welfare Dependence and Education

This study compares administrative and survey data on BC welfare (social assistance) recipients, to test whether survey data is sufficiently accurate for use in policy-oriented research. BC welfare and education data is compared to the 1994 Public Use Microdata (BC sample) of Statistics Canadas Survey of Labour and Income Dynamics (SLID). BC 1994 SLID significantly understates welfare dependence, and overstates education levels of BC welfare recipients. Statistics Canada should lead a national initiative to make provincial administrative datasets available for research; and should use these data to improve key national longitudinal social research surveys such as SLID, NLSCY, and NPHS.

Manufacturing costs of HPV vaccines for developing countries

BACKGROUND Nearly all of the 500,000 new cases of cervical cancer and 270,000 deaths occur in middle or lower income countries. Yet the two most prevalent HPV vaccines are unaffordable to most. Even prices to Gavi, the Vaccine Alliance, are unaffordable to graduating countries, once they lose Gavi subsidies. Merck and Glaxosmithkline (GSK) claim their prices to Gavi equal their manufacturing costs; but these costs remain undisclosed. We undertook this investigation to estimate those costs. METHODS Searches in published and commercial literature for information about the manufacturing of these vaccines. Interviews with experts in vaccine manufacturing. FINDINGS This detailed sensitivity analysis, based on the best available evidence, finds that after a first set of batches for affluent markets, manufacturing costs of Gardasil for developing countries range between

The Impact of Placing Adolescent Males into Foster Care on Education, Income Assistance, and Convictions

0.48 and

Preliminary outcomes and cost‐benefit analysis of a community hospital emergency department screening and referral program for patients aged 75 or more

0.59 a dose, a fraction of its alleged costs of

Extraordinary claims require extraordinary evidence

4.50. Because volume of Cervarix is low, its per unit costs are much higher, though at comparable volumes, its costs would be similar. INTERPRETATION Given the recovery of fixed and annual costs from sales in affluent markets, Mercks break-even price to Gavi could be

Patient safety — how much is enough?

0.50-

Identification of seniors at risk: process evaluation of a screening and referral program for patients aged > or =75 in a community hospital emergency department

0.60, not

Estimated research and development costs of rotavirus vaccines

4.50. These savings could support Gavi programs to strengthen delivery and increase coverage. Outside Gavi, prices to lower- and middle-income countries, with profit, could also be lowered and made available to millions more adolescents at risk. These estimates and their policy implications deserve further discussion.

Setting the record straight in the reply by DiMasi, Hansen and Grabowski

Understanding the causal impacts of taking atrisk youth into government care is part of the evidence base for policy. Two sources of exogenous variation affecting alternative subsets of the atrisk population provide causal impacts interpreted as local average treatment effects. Placing 16 to18yearold males into care decreases or delays high school graduation, increases income assistance receipt, and has alternative effects on criminal convictions depending upon the instrument employed. This suggests that asking whether more or fewer children should be taken into care is insufficient; it also matters which, and how, children are taken into care.