Hoonhout Lilian H F, de Bruijne Martine C, Wagner Cordula, Zegers Marieke, Waaijman Roelof, Spreeuwenberg Peter, Asscheman Henk, van der Wal Gerrit, van Tulder Maurits W
Department of Public & Occupational Health, EMGO Institute, VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
BMC Health Serv Res. 2009 Feb 9;9:27. doi: 10.1186/1472-6963-9-27.
Up to now, costs attributable to adverse events (AEs) and preventable AEs in the Netherlands were unknown. We assessed the total direct medical costs associated with AEs and preventable AEs in Dutch hospitals to gain insight in opportunities for cost savings.
Trained nurses and physicians retrospectively reviewed 7,926 patient records in 21 hospitals. Additional patient information of 7,889 patients was received from the Dutch registration of hospital information. Direct medical costs attributable to AEs were assessed by measuring excess length of stay and additional medical procedures after an AE occurred. Costs were valued using Dutch standardized cost prices.
The annual direct medical costs in Dutch hospitals were estimated at a total of euro 355 million for all AEs and euro 161 million for preventable AEs in 2004. The total number of hospital admissions in which a preventable AE occurred was 30,000 (2.3% of all admissions) and more than 300,000 (over 3% of all bed days) bed days were attributable to preventable AEs in 2004. Multilevel analysis showed that variance in direct medical costs was not determined by differences between hospitals or hospital departments.
The estimates of the total preventable direct medical costs of AEs indicate that they form a substantial part (1%) of the expenses of the national health care budget and are of importance to hospital management. The cost driver of the direct medical costs is the excess length of stay (including readmissions) in a hospital. Insight in which determinants are associated with high preventable costs will offer useful information for policymakers and hospital management to determine starting points for interventions to reduce the costs of preventable AEs.
截至目前，荷兰因不良事件（AE）及可预防的不良事件所产生的费用尚不清楚。我们评估了荷兰医院中与不良事件及可预防的不良事件相关的直接医疗总费用，以了解成本节约的机会。
经过培训的护士和医生对21家医院的7926份患者记录进行了回顾性研究。另外还从荷兰医院信息登记处获取了7889名患者的额外信息。通过测量不良事件发生后的住院时间延长和额外的医疗程序来评估因不良事件产生的直接医疗费用。费用使用荷兰标准化成本价格进行估值。
2004年，荷兰医院因所有不良事件产生的年度直接医疗费用估计总计为3.55亿欧元，因可预防的不良事件产生的费用为1.61亿欧元。2004年发生可预防不良事件的住院总数为30000例（占所有住院病例的2.3%），超过300000个住院日（占所有住院日的3%以上）归因于可预防的不良事件。多水平分析表明，直接医疗费用的差异并非由医院或医院科室之间的差异所决定。
不良事件可预防的直接医疗费用估计表明，它们占国家医疗保健预算支出的很大一部分（1%），对医院管理具有重要意义。直接医疗费用的成本驱动因素是在医院的住院时间延长（包括再次入院）。了解哪些决定因素与高可预防成本相关，将为政策制定者和医院管理提供有用信息，以确定降低可预防不良事件成本的干预起点。
