The Accountability Record | Case-based accountability for healthcare and social systems

Case-based accountability

Connecting real cases to the bigger system failures they reveal.

The Accountability Record documents individual cases of harm and connects them to the wider systems and public indicators around them.

Explore cases See how the framework works For funders and partners

Plain language first Built around documented cases Shows patterns without hiding the people involved

Featured case

Here’s what actually happened.

Transportation barrier

The Case of the $489,000 Air Ambulance Ride

While traveling in Wyoming in 2020, Sean Deines became critically ill and was diagnosed with aggressive leukemia. He was flown by air ambulance to North Carolina for treatment, and the transport generated a $489,000 bill. The case shows how emergency air ambulance pricing can leave seriously ill patients caught between providers and insurers during a medical crisis.

Location

System

Healthcare

Date

November 28, 2020

This case shows how a breakdown in one moment can connect to larger failures in discharge planning, follow-up care, housing support, or service access.

Read full case

Start here

Choose the entry point that fits how you want to learn.

Start with a real case, move to a pattern, or see how the framework works.

Start with a real case

Read a documented event first, then follow it out to the systems and conditions around it.

Open this case

Start with a pattern

See how repeated harms like unsafe discharge or continuity gaps show up across multiple cases.

Open patterns

Start with the framework

See how cases, sources, mechanisms, indicators, and trust notes work together.

Open methodology

Why this exists

Many harms look isolated until the case record is connected to the larger pattern.

Start with the case

What happened to a real person

Every record starts with a documented case, not an abstract category.

Add supporting evidence

What records back it up

Sources, mechanisms, and indicator links make the record reviewable and usable.

Show the broader pattern

What this helps reveal

Linked indicators and pattern pages show when the same failures keep happening across places and systems.

Platform snapshot

Featured metrics and current platform activity.

These are platform activity measures. They describe what is in the public record today. They do not claim direct system impact on their own.

Public cases

Documented public case records available for readers, reporters, advocates, and partners.

Operational

Linked indicators

Public measures used to show larger conditions around documented harms.

Descriptive

Tracked patterns

Curated pattern pages that help readers move from one case to recurring system failures.

Operational

This platform connects what happens in real cases to the larger systems and data used to measure them.

The homepage starts with one real case, then expands outward to the patterns, indicators, and framework behind it.

Featured evidence

Examples of measures that help readers see the bigger story.

Criminalization

Criminal justice revolving door for people in behavioral or medical crisis

Framing indicator capturing the documented pattern in which people experiencing untreated mental illness or acute behavioral crisis are repeatedly pulled into jail instead of receiving appropriate medical or community-based care. Used here to contextualize the criminalization of a visibly impaired emergency patient.

Community condition

Care continuity

30-day readmission rate for schizophrenia

National 30-day all-cause readmission rate for schizophrenia from AHRQ HCUP 2010 data.

CMS

Youth behavioral health access

Adolescents with major depressive episode who did not receive treatment

This indicator captures the national treatment gap for adolescents who experienced a major depressive episode, providing context for cases where youth with known psychiatric risk moved through systems without stable mental health care.

Community condition

Who this is for

Built for readers who need the human case and the measurable context.

General public

Understand what happened in plain English

Short summaries and clear headings help lay readers move from one case to the larger pattern.

Funders and grant reviewers

See why this is measurable accountability work

Operational metrics, framework connections, and trust notes help show rigor without hiding the people involved.

Hospitals, payers, public health, and community partners

Use case evidence alongside existing systems

The platform complements CMS measures, PRAPARE screening, Z codes, CHNA priorities, and local planning efforts.

Partnership and funding

Why this matters for funders and institutional partners.

What this means for funders

Support work that keeps people visible while still producing measurable evidence.

This platform can support funding conversations about health equity, care transitions, community partnerships, behavioral health continuity, and cross-system accountability.

What this means for partners

Use case records to ground system improvement in real failures.

Hospitals, Medicaid managed care organizations, public health departments, and community-based organizations can use the framework to connect lived harm to measurable conditions and response priorities.

View impact and metrics Open frameworks and partnerships

How the framework works

A simple structure for moving from one record to the bigger picture.

1. Record the case

What happened

Capture the event, the systems involved, the barriers present, and why the case matters.

2. Attach the evidence

What supports the record

Add records, reporting, and source notes so readers can see what the case is grounded in.

3. Explain the mechanism

How the harm happened

Name the failures that turned an event into preventable harm.

4. Link public indicators

What the wider conditions look like

Use public measures to show whether the case reflects broader community or system pressure.

5. Group repeated harms

What pattern this belongs to

Pattern pages make recurring harms easier to recognize, discuss, and challenge.