Imperial College London, Imperial College Business School, South Kensington, London, UK.
Med Care. 2011 Dec;49(12):1068-75. doi: 10.1097/MLR.0b013e31822efb09.
Despite extensive research into adverse events, there is no quantitative estimate for the risk of experiencing adverse events per day spent in hospital. This is important information for hospital managers, because they may consider discharging patients earlier to alternative care providers if this is associated with lower risk, but other costs and benefits are similar.
We model adverse events as a function of patient risk factors, hospital fixed effects, and length of stay. Potential endogeneity of length of stay is addressed with instrumental variable methods, using days and months of discharge as instruments. We use administrative hospital episode data for 206,489 medical inpatients in all public hospitals in the state of Victoria, Australia, for the year 2005/2006.
A hospital stay carries a 5.5% risk of an adverse drug reaction, 17.6% risk of infection, and 3.1% risk of ulcer for an average episode, and each additional night in hospital increases the risk by 0.5% for adverse drug reactions, 1.6% for infections, and 0.5% for ulcers. Length of stay is endogenous in models of adverse events, and risks would be underestimated if length of stay was treated as exogenous.
The results of our research contribute to assessing the benefits and costs of hospital stays-and their alternatives-in a quantitative manner. Instead of discharging patients early to alternative care, it would be more desirable to address underlying causes of adverse events. However, this may prove costly, difficult, or impossible, at least in the short run. In such situations, our research supports hospital managers in making informed treatment and discharge decisions.
尽管已经对不良事件进行了广泛的研究，但每天在医院住院所经历的不良事件的风险仍没有定量估计。这对于医院管理者来说是一个重要的信息，因为如果这种风险较低，他们可能会考虑将患者更早地转移到替代护理提供者那里，但是其他成本和收益是相似的。
我们将不良事件建模为患者风险因素、医院固定效应和住院时间的函数。使用出院天数和月份作为工具变量，解决了住院时间的潜在内生性问题。我们使用 2005/2006 年澳大利亚维多利亚州所有公立医院的 206489 名住院患者的行政住院病例数据。
对于一个平均的住院病例，药物不良反应的风险为 5.5%，感染的风险为 17.6%，溃疡的风险为 3.1%，每多住一个晚上，药物不良反应的风险增加 0.5%，感染的风险增加 1.6%，溃疡的风险增加 0.5%。在不良事件模型中，住院时间是内生的，如果将住院时间视为外生的，风险就会被低估。
我们的研究结果有助于以定量的方式评估住院及其替代方案的收益和成本。与其将患者过早地转移到替代护理中，不如更希望解决不良事件的根本原因。然而，这在短期内可能是昂贵的、困难的或不可能的。在这种情况下，我们的研究支持医院管理者做出明智的治疗和出院决策。
