Kaveh G. Shojania, MD

kshojania@ohri.ca
Affiliate Investigator, Clinical Epidemiology, Ottawa Hospital Research Institute

Assistant Professor of Medicine, University of Ottawa

Staff Physician, Department of Medicine, The Ottawa Hospital

RESEARCH INTERESTS
  • Medical error and patient safety
  • Quality measurement for hospital care
  • Quality improvement, knowledge translation
  • Evidence synthesis: systematic reviews and meta-analysis
  • Clinical information systems and computerized order entry
SELECTED AWARDS

2005 Tier 2 Canada Research Chair in Patient Safety and Quality in Improvement

2004 John M. Eisenberg Patient Safety Award from the National Quality Forum and the Joint Commission on Accreditation of Healthcare Organizations. Awarded jointly with Robert M. Wachter, MD for "Innovation in Patient Safety and Quality at a National Level."

2002 Young Investigator Award from the Society for Hospital Medicine, the American College of Physicians-affiliated professional society for hospitalists.

PUBLICATIONS

Peer Reviewed Journal Articles

1. Shojania KG, Fletcher KE, Saint S. Graduate medical education and patient safety: a busy-and occasionally hazardous-intersection. Ann Intern Med. 2006; 145(8):592-8.

2. Ranji S, Goldman LE, Simel D, Shojania KG. Does administering narcotics to patients with acute abdominal pain affect the physical examination or diagnostic accuracy? A meta-analysis. JAMA. 2006:296(14):1764-74.

3. Kalus RM. Shojania KG, Amory JK, Sanjay S. Clinical problem-solving. Lost in Transcription. N Engl J Med. 2006; 355(14):1487-1491.

4. Shojania KG, Ranji S, McDonald KM, Sundaram V, Grimshaw JM, Rushakoff RJ, Owens DK. The effects of specific quality improvement strategies on diabetic glycemic control: a meta-analysis. JAMA. 2006; 296(4):427-440.

5. Walsh JME, McDonald KM, Shojania KG, Sundaram V, Lewis R, Nayak S, Mechanic J, Owens DK, Goldstein MK. Quality Improvement Strategies for Hypertension Management: A Systematic Review. Med Care. 2006; 44(7):646-657.

6. Steinman MA, Ranji SR, Shojania KG, Gonazales R. Improving Antibiotic Selection: A Systematic Review and Quantitative Analysis of Quality Improvement Strategies. Medical Care. 2006; 44(7):617-628.

7. Shojania KG, Burton EC, McDonald KM, Goldman L. The Overestimation of Clinical Diagnostic Performance Caused by Low Autopsy Rates. Qual Saf Health Care. 2005; 14(6): 408-413.

8. Bravata DM, McDonald KM, Shojania KG, Sundaram V, Owens DK. Challenges in systematic reviews: synthesis of topics related to the delivery, organization, and financing of health care. Ann Intern Med. 2005; 142(12 Pt 2):1056-1065.

9. Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Affairs. 2005; 24(1):138-150.

10. Dezfulian C, Shojania K, Collard HC, Saint S. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med. 2005; 118(1); 11-18.

11. Wachter RM, Shojania KG. The faces of errors: a case-based approach to educating providers, policymakers, and the public about patient safety. Jt Comm J Qual Saf. 2004; 30(12):665-70.

12. Nallamothu BK, Shojania KG, Hofer TP, Saint S, Humes HD, Moscucci M, Bates ER. Is acetylcysteine effective in preventing contrast-related nephropathy? A meta-analysis. Am J Med. 2004; 117:938-47.

13. Bent S, Shojania KG, Saint S. The use of systematic reviews and meta-analyses in infection control and hospital epidemiology. Am J Infect Control. 2004; 32(4):246-54.

14. Jha AK, Shojania KG, Saint S. Clinical problem-solving. Forgotten but not gone. N Engl J Med. 2004; 350(23)2399-2404.

15. Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 2003; 289(21):2849-56.

16. Kachalia A, Shojania KG, Hofer TP, Piotrowski M, Saint S. Does full disclosure of medical errors impact malpractice liability? The jury is still out. Jt Comm J Qual Saf. 2003; 29(10):503-11.

17. Astion ML, Shojania KG, Hamill TR, Kim S, Ng VL. Classifying laboratory incident reports to identify problems that jeopardize patient safety. Am J Clin Pathol. 2003l; 120(1):18-26.

18. Kaushal R, Shojania KG, Bates DW. The effects of computerized physician order entry and clinical decision support systems: a systematic review. Arch Intern Med. 2003; 163(12):1409-16.

19. Trowbridge R. Rutkowski K, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003; 289(1):80-6.

20. Shojania KG, Duncan BW, McDonald KM, Wachter RM. Safe but sound: patient safety meets evidence-based medicine. JAMA. 2002; 288(4):508-13.

21. Shojania KG, Wald H, Gross R. Understanding medical error and improving patient safety in the inpatient setting. Med Clin North Am. 2002; 86(4):847-67.

22. Shojania KG, Olmsted RN. Searching the healthcare literature efficiently: from clinical decision-making to continuing education. Am J Infect Control. 2002; 30(3):187-95.

23. Shojania KG, Bero LA. Taking advantage of the explosion of systematic reviews: an efficient MEDLINE search strategy for identifying systematic reviews of the literature. Eff Clin Pract. 2001; 4(4):157-62. The electronic search strategy developed and evaluated in this paper was adapted by the National Library of Medicine as the search filter for systematic reviews in the Clinical Queries section of PubMed, as cited and acknowledged at: http://www.nlm.nih.gov/bsd/pubmed_subsets/sysreviews_sources.html .

24. Shojania KG, Burton EC, Mcdonald KM, Goldman L. The autopsy as an outcome and performance measure. Evid Rep Technol Assess (Summ). 2002; (58):1-5

25. Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001; (43):i-x, 1-668. Over 100,000 copies of this synthesis of the patient safety literature have been obtained in hard copy or downloaded from the Agency for Healthcare Research and Quality website at http://www.ahrq.gov/clinic/ptsafety/

26. Shojania KG, Showstack J, Wachter RM. Assessing hospital quality: a review for clinicians. Eff Clin Pract. 2001; 4(2):82-90.

27. Shojania KG, Yokoe D, Platt R, Fiskio J, Ma'luf N, Bates DW. Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J Am Med Inform Assoc. 1998; 5(6):554-62.

Peer Reviewed Technical Reports

1. Ranji SR, Steinman MA, Shojania KG, Gonzales R, Sundaram V, Lewis R, Arnold S. Antibiotic Prescribing Behavior. Vol. 4 of: Shojania KG, McDonald KM, Wachter RM, Owens DK, editors. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Technical Review 9 (Prepared by the Stanford University-UCSF Evidence-based Practice Center under Contract No. 290-02-0017). AHRQ Publication No. 04(06)-0051-4. Rockville, MD: Agency for Healthcare Research and Quality. January 2006. Available online at: http://www.ahrq.gov/downloads/pub/evidence/pdf/medigap/medigap.pdf

2. Shojania KG, Mcdonald KM, Wachter RM, Owens DK. Closing The Quality
Gap: A Critical Analysis Of Quality Improvement Strategies, Volume 1-- Series Overview And Methodology. AHRQ Publication No. 04-0051-1. Rockville, MD: Agency for Healthcare Research and Quality. August 2004. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/qualgap1/contents.pdf

3. Shojania KG, Ranji S, Shaw LK, Charo LN, Lai JC, Rushakoff RJ, McDonald KM, Owens DK. Closing The Quality Gap: A Critical Analysis Of Quality Improvement Strategies, Volume 2 - Diabetes Mellitus Care. AHRQ Publication No. 04-0051-2. Rockville, MD: Agency for Healthcare Research and Quality. September 2004. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/qualgap2/qualgap2.pdf

4. Walsh JM, McDonald KM, Shojania KG, Sundaram V, Lewis R, Nayak S, Mechanic J, Owens DK, Goldstein MK. Closing The Quality Gap: A Critical Analysis Of Quality Improvement Strategies, Volume 3 - Hypertension Care AHRQ Publication No. 04-0051-3. Rockville, MD: Agency for Healthcare Research and Quality. January 2005. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/qualgap3/qualgap3.pdf

5. Davies S, Geppert J, Mclellan M, McDonald K, Romano P, Shojania KG. Measures of Patient Safety Based on Hospital Administrative Data-the Patient Safety Indicators. File Inventory, Technical Review Number 5. AHRQ Publication No. 02-0038, August 2002. Agency for Healthcare Research and Quality, Rockville, MD. Available online at:
http://www.ahrq.gov/clinic/psindinv.htm

6. Davies S, Geppert J, Mclellan M, McDonald K, Romano P, Shojania KG. Refinement of the HCUP Quality Indicators Hospital Costs and Utilization Project (HCUP). Technical Report No. 4 from the UCSF-Stanford Evidence-based Practice Center for the Agency for Healthcare Research and Quality. AHRQ Publication No. 01-0035; May 2001. Available online at:http://www.ahrq.gov/clinic/hcupqinv.htm

7. Sheryl M. Davies, Jeffrey Geppert, Mark McClellan, Kathryn M. McDonald, Patrick S. Romano, and Kaveh G. Shojania, "Hospital Nursing Staff Ratios and Quality of Care: Final Report on Evidence, Administrative Data, an Expert Panel Process, and a Hospital Nurse Staffing Survey 011" (May 1, 2001). Center for Health Services Research in Primary Care. Reports prepared for the California Department of Health Services. Available online at: http://repositories.cdlib.org/chsrpc/cdhs/hcupqi011

Editorials, Commentaries, and Invited Reviews

1. Wachter RM, Shojania KG, Markowitz AJ, Smith M, Saint S. Quality Grand Rounds: The Case for Patient Safety. Ann Intern Med. 2006; 145(8):629-630.

2. Shojania KG. Safe medication prescribing and monitoring in the outpatient setting.
CMAJ. 2006;174(9):1257-1258.

3. Forster AJ, Shojania KG, van Walraven C. Improving patient safety - moving beyond the "hype" of medical errors. CMAJ. 2005; 173(8):893-4.

4. Shojania KG, Grimshaw JM. Still no magic bullets: pursuing more rigorous research in quality improvement. Am J Med. 2004; 116(11):778-780.

5. Shojania KG, Burton EC. The persistent value of the autopsy. Am Fam Physician. 2004 ; 69(11):2540-2.

6. Shojania KG, Mariani SM, Lundberg GD. MedGenMed's selection of the top 10 medical/health stories of 2002. Med Gen Med. 2002; 4(4):2. Available online at: http://www.medscape.com/viewarticle/446310

7. Wachter RM, Shojania KG, Saint S, Markowitz AJ, Smith M. Learning from our mistakes: quality grand rounds, a new case-based series on medical errors and patient safety. Ann Intern Med. 2002; 136(11):850-2.

Books

1. Wachter RM, Shojania KG. Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes. New York: Rugged Land Publishing; February 2004. This book for a general audience has sold approximately 45,000 copies since its release in in 2004 and received excellent reviews in the New York Times (Science Section, February 10, 2004), San Francisco Chronicle (February 23, 2004), Baltimore Sun (March 1, 2004), British Medical Journal (July 3, 2004), and Journal of the American Medical Association (Jan 18, 2006).

Book Chapters

1. Shojania KG. Erythema nodosum. In: Up-To-Date, Rose BD, editor. Up-To-Date Inc., Wellesley, MA, 2006.

2. Wachter RM, Shojania KG, Minichiello T, Flanders SA, Hartman EH. WebM&M-An Online Journal of Medical Error Reporting and Analysis. In: Advances in Patient Safety: From Research to Implementation. Agency for Healthcare Research and Quality, Rockville, MD; 2005. Available at: http://www.ahrq.gov/qual/advances/

3. Fein S, Hilborne L, Kagawa-Singer M, Spiritus E, Keenan C, Seymann G, Shojania KG, Wenger N. A Conceptual Model for Disclosure of Medical Errors. In: Advances in Patient Safety: From Research to Implementation. Agency for Healthcare Research and Quality, Rockville, MD; 2005. Available at: http://www.ahrq.gov/qual/advances/

4. Shojania KG. Patient Safety in the Hospitalized Patient. In: Hospital Medicine. (2nd Edition) Wachter RM, Hollander H, Goldman L, editors. Lippincott Williams and Wilkins; 2005.

5. Shojania KG. Nosocomial Complications in Hospitalized Patients. In: Saint Francis Guide to Inpatient Medicine. (2nd Edition) Saint S and Frances C, editors. Lippincott Williams and Wilkins; 2003.

6. Wald H. and Shojania KG. The use of bar coding to enhance patient safety. In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058; July 2001. Available online at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.section.61949

7. Wald H. and Shojania KG . Incident reporting. In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058; July 2001. Available online at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.section.59490

8. Wald H. and Shojania KG . Root cause analysis. In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058; July 2001. Available online at:
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.section.59569

9. Martens SB and Shojania KG. Patient safety during transportation of critically ill patients. In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058; July 2001. Full report at http://www.ahrq.gov/clinic/ptsafety/

10. Gandhi TK, Shojania KG, Bates DW. Protocols for High-Risk Drugs: Reducing Adverse Drug Events Related to Anticoagulants. In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058; July 2001. Available online at http://www.ahrq.gov/clinic/ptsafety/

11. Murray MD, Shojania KG. Unit-Dose Drug Distribution Systems. In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058; July 2001. Available online at http://www.ahrq.gov/clinic/ptsafety/

ACTIVE FUNDING

1. Understanding Wait Lists for MRI: Appropriateness of Utilization and Triaging of Priority. Canadian Institutes of Health Research (CIHR # FRN 81218). 2006-2009; $433,098. Role on project: Co-Principal Investigator.

2. Implementing Patient Safety Practices in Pediatrics and Adult Health Care. Canadian Health Services Research Foundation and Canadian Patient Safety Institute (CHSRF # RC2-1286-06). 2006-2010; $790,000. Role on project: Co-Principal Investigator.

This project will use a qualitative research methodology involving semi-structured interviews of administrative and clinical personnel at approximately 60 hospitals across Canada to evaluate the state of implementation for three patient safety interventions, computerized provider order entry, removal of potassium from general wards, and a third intervention to be determined after pilot data collection. (These interventions were deliberately chosen to be as different as possible, except for their both being widely recommended.) The project will specifically address barriers to implementation for the chosen safety practices.

3. Do physician judgment biases predict inappropriate use of treatments? Canadian Institutes of Health Research (CIHR-# KTS-73432). 2005-2008; $244,505. Role on project: Co- Investigator.

4. Updating Systematic Reviews. US Agency for Healthcare Research and Quality (AHRQ Contract #290-02-0021, Task Order #1, Assignment #7). Jan 2006-2007; $256,425 US. Role on project: Co-PI (with David Moher, PhD).

It is generally recognized that systematic reviews become out of date, but no empiric data guide recommendations about how to look for new studies and assess the need to update published reviews. This project will define a cohort of 200 randomly selected systematic reviews and meta-analyses to determine the average time before appearance of a new study that would warrant updating the previous review. The need to update a previous systematic review will be defined operationally in terms of various criteria related to the design and results of the new study (e.g., does the new study have methodological features not present in the previously published studies? Does the new study report an effect that differs significantly from the previously reported results?). The project will also seek to identify features of systematic reviews-including characteristics related to the content area, features of the included studies, and the nature of the results-that increase or decrease the time before appearance of a new study that indicates the need to update the previous analysis.

5. Can an interactive voice response system be used to identify post-discharge adverse events? Canadian Patient Safety Institute. Feb 2006-2007; $239,000. Role on project: Co-investigator.

The purpose of this project is to evaluate the effectiveness of an interactive, automated telephone system for calling patients after discharge from the hospital to identify actual or potential adverse events and bring them to providers' attention in a timely manner.

6. A comparison of methods to evaluate patient safety during hospital care. Canadian Institutes of Health Research (CIHR #PHE-79037). March 2006-2008;$400,000. Role on project: Co-investigator

This study will compare the yields of different methods for identifying adverse events and other important safety problems. Example methods include prospective surveillance, retrospective chart review, and natural language screening of discharge summaries, operative reports, and electronically captured clinical records.

7. Improving the Confidence of Adverse Event Ratings. Canadian Institutes of Health Research (CIHR #CPS-79977) March 2006-2008; $150,000 Role on project: Co-investigator.

Some studies of adverse events have acknowledged the problem of inter-rater reliability, but have generally not considered the peer review process as a diagnostic test. Judgment by a reviewer that an adverse event has occurred amounts to representing the result of a diagnostic test, with the post-test probability of an adverse event having occurred depending on the sensitivity and specificity of the test and the prevalence of adverse events in the population under study. This study will use the technique of latent class analysis to back calculate the sensitivity, specificity, and prevalence of adverse events using data from at least three independent reviewers. It will also use larger number of reviewers to determine the factors that increase or decrease inter-rater reliability in judgments of adverse events.

8. Canada Research Chair in Patient Safety and Quality Improvement. Government of Canada Research Chairs Program. Feb 2005-2010; $500,000 This is a 5-year individual award to support a research program over a five year period. The research program will include projects in the following five areas.
  • Improving methods for identifying adverse events
  • Characterizing the relatively unstudied epidemiology of diagnostic errors,
  • Investigating the role of "cognitive biases" affecting diagnostic reasoning,
  • Developing an ongoing resource of regularly updated systematic reviews aimed at identifying evidence-based interventions that improve patient safety,
  • Identifying strategies for successfully disseminating evidence-based interventions, with a particular focus on elucidating organizational factors that predict successful implementation of computerized order entry, perhaps the most widely called for patient safety intervention.