Runciman W B, Webb R K, Helps S C, Thomas E J, Sexton E J, Studdert D M, Brennan T A
Department of Anaesthesia and Intensive Care, University of Adelaide, Australia.
Int J Qual Health Care. 2000 Oct;12(5):379-88. doi: 10.1093/intqhc/12.5.379.
To better understand the remaining three-fold disparity between adverse event (AE) rates in the Quality in Australia Health Care Study (QAHCS) and the Utah-Colorado Study (UTCOS) after methodological differences had been accounted for.
Iatrogenic injury in hospitalized patients in Australia and America.
Using a previously developed classification, all AEs were assigned to 98 exclusive descriptive categories and the relative rates compared between studies; they were also compared with respect to severity and death.
The distribution of AEs amongst the descriptive and outcome categories.
For 38 categories, representing 67% of UTCOS and 28% of QAHCS AEs, there were no statistically significant differences. For 33, representing 31% and 69% respectively, there was seven times more AEs in QAHCS than in UTCOS. Rates for major disability and death were very similar (1.7% and 0.3% of admissions for both studies) but the minor disability rate was six times greater in QAHCS (8.4% versus 1.3%).
A similar 2% core of serious AEs was found in both studies, but for the remaining categories six to seven times more AEs were reported in QAHCS than in UTCOS. We hypothesize that this disparity is due to different thresholds for admission and discharge and to a greater degree of under-reporting of certain types of problems as AEs by UTCOS than QAHCS reviewers. The biases identified were consistent with, and appropriate for, the quite different aims of each study. No definitive difference in quality of care was identified by these analyses or a literature review.
在考虑方法学差异之后，更好地理解澳大利亚医疗保健质量研究（QAHCS）和犹他 - 科罗拉多研究（UTCOS）中不良事件（AE）发生率之间仍存在的三倍差距。
澳大利亚和美国住院患者的医源性损伤。
使用先前制定的分类方法，将所有不良事件归入98个互斥的描述性类别，并比较研究之间的相对发生率；还就严重程度和死亡情况进行了比较。
不良事件在描述性类别和结果类别中的分布情况。
对于38个类别（占UTCOS不良事件的67%和QAHCS不良事件的28%），无统计学显著差异。对于另外33个类别（分别占31%和69%），QAHCS中的不良事件发生率是UTCOS中的7倍。严重残疾和死亡发生率非常相似（两项研究中均为入院患者的1.7%和0.3%），但QAHCS中的轻度残疾发生率是UTCOS中的6倍（8.4%对1.3%）。
两项研究中均发现约2%的严重不良事件核心相似，但对于其余类别，QAHCS报告的不良事件比UTCOS多6至7倍。我们推测这种差异是由于入院和出院阈值不同，以及UTCOS比QAHCS的评审人员对某些类型问题作为不良事件的漏报程度更高。所发现的偏差与每项研究截然不同的目的一致且相符。这些分析或文献综述未发现护理质量存在明确差异。
