医疗导致的患者伤害发生率的时间趋势。

Temporal trends in rates of patient harm resulting from medical care.

机构信息

Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical, Boston, MA 02115, USA.

出版信息

N Engl J Med. 2010 Nov 25;363(22):2124-34. doi: 10.1056/NEJMsa1004404.

DOI:10.1056/NEJMsa1004404

PMID:21105794

Abstract

BACKGROUND

In the 10 years since publication of the Institute of Medicine's report To Err Is Human, extensive efforts have been undertaken to improve patient safety. The success of these efforts remains unclear.

METHODS

We conducted a retrospective study of a stratified random sample of 10 hospitals in North Carolina. A total of 100 admissions per quarter from January 2002 through December 2007 were reviewed in random order by teams of nurse reviewers both within the hospitals (internal reviewers) and outside the hospitals (external reviewers) with the use of the Institute for Healthcare Improvement's Global Trigger Tool for Measuring Adverse Events. Suspected harms that were identified on initial review were evaluated by two independent physician reviewers. We evaluated changes in the rates of harm, using a random-effects Poisson regression model with adjustment for hospital-level clustering, demographic characteristics of patients, hospital service, and high-risk conditions.

RESULTS

Among 2341 admissions, internal reviewers identified 588 harms (25.1 harms per 100 admissions; 95% confidence interval [CI], 23.1 to 27.2) [corrected]. Multivariate analyses of harms identified by internal reviewers showed no significant changes in the overall rate of harms per 1000 patient-days (reduction factor, 0.99 per year; 95% CI, 0.94 to 1.04; P=0.61) or the rate of preventable harms. There was a reduction in preventable harms identified by external reviewers that did not reach statistical significance (reduction factor, 0.92; 95% CI, 0.85 to 1.00; P=0.06), with no significant change in the overall rate of harms (reduction factor, 0.98; 95% CI, 0.93 to 1.04; P=0.47).

CONCLUSIONS

In a study of 10 North Carolina hospitals, we found that harms remain common, with little evidence of widespread improvement. Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety over time. (Funded by the Rx Foundation.).

摘要

背景

自 2000 年美国医学研究所（Institute of Medicine）发布《人非圣贤，孰能无过》（To Err Is Human）报告以来，已过去 10 年。这期间，人们进行了大量努力来提高患者安全性，但收效尚不明朗。

方法

我们对北卡罗来纳州的 10 家医院进行了分层随机抽样，回顾性研究了 2002 年 1 月至 2007 年 12 月期间每个季度的 100 例住院患者。由院内（内部审核员）和院外（外部审核员）护士审核团队采用美国医疗改进协会（Institute for Healthcare Improvement）的全球触发工具（Global Trigger Tool）来测量不良事件，按顺序随机审核。初次审核发现疑似伤害后，由两名独立的医生审核员进行评估。我们使用随机效应泊松回归模型进行危害发生率评估，模型调整了医院层面的聚类、患者人口统计学特征、医院服务和高危情况。

结果

在 2341 例住院患者中，内部审核员共发现 588 例伤害（25.1 例/100 例住院患者；95%置信区间[CI]，23.1 至 27.2）。多变量分析显示，内部审核员发现的伤害总发生率（每年减少 0.99；95%CI，0.94 至 1.04；P=0.61）或可预防伤害发生率无显著变化。外部审核员发现的可预防伤害有所减少，但未达统计学显著水平（减少 0.92；95%CI，0.85 至 1.00；P=0.06），伤害总发生率也无显著变化（减少 0.98；95%CI，0.93 至 1.04；P=0.47）。