Amelung Stefanie, Meid Andreas D, Nafe Michael, Thalheimer Markus, Hoppe-Tichy Torsten, Haefeli Walter E, Seidling Hanna M
Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany.
Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany.
Int J Clin Pract. 2017 Oct;71(10). doi: 10.1111/ijcp.12990. Epub 2017 Sep 5.
Using clinical administrative data (CAD) of inpatients, we aimed to identify ICD-10 codes coding for potentially preventable inhospital adverse drug events (ADE) that affect the length of hospital stay (LOS) and thus patient well-being and cost.
We retrospectively assessed CAD of all inpatient stays in 2012 of a German university hospital. Predefined ICD-10 codes indicating ADE (ADE codes) were further specified based on expert ratings of the ADE mechanism and ADE preventability in clinical routine to particularly identify preventable inhospital ADE. In a propensity-matched cohort design, we compared patients with one or more ADE codes to control patients with regard to differences in LOS for three situations: all cases with an ADE code, cases with an inhospital ADE code, and cases with a preventable inhospital ADE code.
Out of 54 032 cases analysed, in 8.3% (N=4 462) at least one ADE code was present. Nine of 128 evaluated ADE codes were rated as preventable in clinical routine, relating to 220 inpatients (4.9% of all identified inpatients with at least one ADE code and 0.4% of the entire cohort, respectively). Out of 48 072 evaluable inpatients for propensity score matching, 7 938 controls without ADE code and 4 006 cases with ADE code were selected. In all three settings, cases showed prolonged LOS vs controls (delta 1.13 d; 0.88 d and 1.88 d, respectively), significantly exceeding the maximum LOS as defined for each Diagnosis-Related Group.
Inpatients with ADE codes referring to inhospital, potentially preventable ADE exceeded the maximum hospital stay fully reimbursed by insurance companies, indicating unnecessary long and costly inpatient stays.
利用住院患者的临床管理数据（CAD），我们旨在识别国际疾病分类第十版（ICD - 10）编码中那些编码为可能可预防的住院药物不良事件（ADE）的情况，这些事件会影响住院时间（LOS），进而影响患者的健康和成本。
我们回顾性评估了一家德国大学医院2012年所有住院患者的CAD。基于临床常规中对ADE机制和ADE可预防性的专家评级，进一步明确了指示ADE的预定义ICD - 10编码（ADE编码），以特别识别可预防的住院ADE。在倾向匹配队列设计中，我们针对三种情况比较了有一个或多个ADE编码的患者与对照患者在住院时间上的差异：所有有ADE编码的病例、有住院ADE编码的病例以及有可预防的住院ADE编码的病例。
在分析的54032例病例中，8.3%（N = 4462）至少有一个ADE编码。在128个评估的ADE编码中，有9个在临床常规中被评为可预防，涉及220名住院患者（分别占所有识别出的至少有一个ADE编码的住院患者的4.9%和整个队列的0.4%）。在48072例可用于倾向得分匹配的住院患者中，选择了7938例无ADE编码的对照患者和4006例有ADE编码的病例。在所有三种情况下，病例的住院时间均比对照患者延长（差值分别为1.13天、0.88天和1.88天），显著超过了每个诊断相关组定义的最长住院时间。
涉及住院、可能可预防的ADE的ADE编码的住院患者超过了保险公司全额报销的最长住院时间，表明存在不必要的长时间和高成本住院。
