2005-2011 年四种常见疾病的患者安全国家趋势。
National trends in patient safety for four common conditions, 2005-2011.
机构信息
From Qualidigm, Wethersfield (Y.W., M.L.M., N.R.V., T.P.M., M.M.P., J.M.F., S.-Y.H., D.G.), the Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington (M.L.M.), and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (Y.W., H.M.K.), the Department of Health Policy and Management, Yale School of Public Health (H.M.K.), and the Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program (H.M.K.) and the Section of General Internal Medicine (T.P.M., D.G., H.M.K.), Department of Internal Medicine, Yale University School of Medicine, New Haven - all in Connecticut; the Department of Biostatistics, Harvard School of Public Health (Y.W.), and the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (J.M.F.) - all in Boston; and the Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville (N.E., J.B.), and the Centers for Medicare and Medicaid Services, Department of Health and Human Services, Baltimore (R.E.K., N.S.) - both in Maryland.
出版信息
N Engl J Med. 2014 Jan 23;370(4):341-51. doi: 10.1056/NEJMsa1300991.
BACKGROUND
Changes in adverse-event rates among Medicare patients with common medical conditions and conditions requiring surgery remain largely unknown.
METHODS
We used Medicare Patient Safety Monitoring System data abstracted from medical records on 21 adverse events in patients hospitalized in the United States between 2005 and 2011 for acute myocardial infarction, congestive heart failure, pneumonia, or conditions requiring surgery. We estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations.
RESULTS
The study included 61,523 patients hospitalized for acute myocardial infarction (19%), congestive heart failure (25%), pneumonia (30%), and conditions requiring surgery (27%). From 2005 through 2011, among patients with acute myocardial infarction, the rate of occurrence of adverse events declined from 5.0% to 3.7% (difference, 1.3 percentage points; 95% confidence interval [CI], 0.7 to 1.9), the proportion of patients with one or more adverse events declined from 26.0% to 19.4% (difference, 6.6 percentage points; 95% CI, 3.3 to 10.2), and the number of adverse events per 1000 hospitalizations declined from 401.9 to 262.2 (difference, 139.7; 95% CI, 90.6 to 189.0). Among patients with congestive heart failure, the rate of occurrence of adverse events declined from 3.7% to 2.7% (difference, 1.0 percentage points; 95% CI, 0.5 to 1.4), the proportion of patients with one or more adverse events declined from 17.5% to 14.2% (difference, 3.3 percentage points; 95% CI, 1.0 to 5.5), and the number of adverse events per 1000 hospitalizations declined from 235.2 to 166.9 (difference, 68.3; 95% CI, 39.9 to 96.7). Patients with pneumonia and those with conditions requiring surgery had no significant declines in adverse-event rates.
CONCLUSIONS
From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. (Funded by the Agency for Healthcare Research and Quality and others.).
背景
在医疗保险患者中，常见医疗状况和需要手术的状况的不良事件发生率的变化在很大程度上仍不清楚。
方法
我们使用从 2005 年至 2011 年期间美国因急性心肌梗死、充血性心力衰竭、肺炎或需要手术的患者的医疗记录中提取的医疗保险患者安全监测系统数据，研究了 21 种不良事件中发生不良事件的风险患者的发生率、发生一个或多个不良事件的患者比例以及每 1000 例住院患者的不良事件数量。
结果
这项研究包括 61523 名因急性心肌梗死（19%）、充血性心力衰竭（25%）、肺炎（30%）和需要手术（27%）住院的患者。2005 年至 2011 年间，急性心肌梗死患者的不良事件发生率从 5.0%降至 3.7%（差异 1.3 个百分点；95%置信区间[CI]为 0.7 至 1.9），发生一个或多个不良事件的患者比例从 26.0%降至 19.4%（差异 6.6 个百分点；95%CI 为 3.3 至 10.2），每 1000 例住院患者的不良事件数量从 401.9 降至 262.2（差异 139.7；95%CI 为 90.6 至 189.0）。充血性心力衰竭患者的不良事件发生率从 3.7%降至 2.7%（差异 1.0 个百分点；95%CI 为 0.5 至 1.4），发生一个或多个不良事件的患者比例从 17.5%降至 14.2%（差异 3.3 个百分点；95%CI 为 1.0 至 5.5），每 1000 例住院患者的不良事件数量从 235.2 降至 166.9（差异 68.3；95%CI 为 39.9 至 96.7）。肺炎和需要手术的患者的不良事件发生率没有显著下降。
结论
2005 年至 2011 年间，急性心肌梗死或充血性心力衰竭住院患者的不良事件发生率大幅下降，但肺炎或需要手术的住院患者则没有。（由医疗保健研究与质量局和其他机构资助）。
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