Thomas E J, Studdert D M, Newhouse J P, Zbar B I, Howard K M, Williams E J, Brennan T A
University of Texas-Houston Medical School 77030, USA.
Inquiry. 1999 Fall;36(3):255-64.
Patient injuries are thought to have a substantial financial impact on the health care system, but recent studies have been limited to estimating the costs of adverse drug events in teaching hospitals. This analysis estimated the costs of all types of patient injuries from a representative sample of hospitals in Utah and Colorado. We detected 459 adverse events (of which 265 were preventable) by reviewing the medical records of 14,732 randomly selected 1992 discharges from 28 hospitals. The total costs (all results are discounted 1996 dollars) were $661,889,000 for adverse events, and $308,382,000 for preventable adverse events. Health care costs totaled $348,081,000 for all adverse events and $159,245,000 for the preventable adverse events. Fifty-seven percent of the adverse event health care costs, and 46% of the preventable adverse event costs were attributed to outpatient medical care. Surgical complications, adverse drug events, and delayed or incorrect diagnoses and therapies were the most expensive types of adverse events. The costs of adverse events were similar to the national costs of caring for people with HIV/AIDS, and totaled 4.8% of per capita health care expenditures in these states.
患者损伤被认为会对医疗保健系统产生重大经济影响,但近期研究仅限于估算教学医院中药物不良事件的成本。本分析估算了犹他州和科罗拉多州具有代表性的医院样本中各类患者损伤的成本。通过查阅28家医院1992年随机抽取的14732份出院病历,我们检测到459起不良事件(其中265起是可预防的)。不良事件的总成本(所有结果均按1996年美元折现)为6.61889亿美元,可预防不良事件的成本为3.08382亿美元。所有不良事件的医疗保健成本总计3.48081亿美元,可预防不良事件的成本为1.59245亿美元。不良事件医疗保健成本的57%以及可预防不良事件成本的46%归因于门诊医疗。手术并发症、药物不良事件以及诊断和治疗延迟或错误是最昂贵的不良事件类型。不良事件的成本与全国照顾艾滋病毒/艾滋病患者的成本相似,占这些州人均医疗保健支出的4.8%。