Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom.
Nottingham University Business School, Nottingham NG8 1BB, United Kingdom.
Soc Sci Med. 2017 Dec;195:83-89. doi: 10.1016/j.socscimed.2017.11.016. Epub 2017 Nov 11.
Care quality is important to patients and providers, but is hard to measure. This study aimed to examine changes in the frequency and severity of one quality measure - adverse events associated with medical care - in Great Britain over a 12-year period when available resources initially expanded and were subsequently constrained. Data on perceived adverse events, collected from two representative population surveys in 2001 and 2013, were analysed and compared. The samples consisted of 8202 adults aged 15 and over in 2001 and 19,746 adults aged 15 and over in 2013. The main outcome measures were self-reported illness, injury or impairment caused in the opinion of the respondent by medical treatment or care. Respondents were also asked about the perceived severity of harm in terms of health and work, and any actions taken in response. The proportion of all respondents reporting that over the last three years they had suffered some illness, injury or impairment that in their opinion was caused by their medical treatment or care was 2.5% (497/19746) in 2013, compared with 4.8% (391/8202) in 2001, a reduction of 33% after adjusting for age, gender, income and social class differences between the two surveys. Perceived impact on health and work of these events was similar in both surveys, as was the proportion of injured respondents who pursued a legal claim for financial compensation, at 11% (53/497) in 2013 and 10.5% (41/391) in 2001. We also report multivariate analyses of perceived harm rates and severity, and propensity to seek, and accept, compensation. Our results suggest that the NHS became significantly safer over this period when measured by patient perceived harm from medical care. Our survey method could provide a valuable contribution to the monitoring of trends in health-care related adverse events and the impact of patient safety initiatives.
医疗质量对患者和医护人员都很重要，但却难以衡量。本研究旨在探讨在英国，医疗资源最初扩张、随后受限的 12 年间，一个质量指标（与医疗相关的不良事件）的发生频率和严重程度的变化。该研究分析并比较了 2001 年和 2013 年两次具有代表性的人口调查中收集到的感知不良事件数据。样本由 2001 年的 8202 名 15 岁及以上成年人和 2013 年的 19746 名 15 岁及以上成年人组成。主要结局指标为受访者认为因医疗或护理而导致的疾病、伤害或功能障碍。受访者还被问及他们所感知到的伤害对健康和工作的严重程度，以及任何因此而采取的行动。在过去三年中，受访者自述因医疗或护理而遭受某种疾病、伤害或功能障碍的比例为 2.5%（497/19746），2013 年比 2001 年的 4.8%（391/8202）有所下降，调整两个调查之间的年龄、性别、收入和社会阶层差异后，下降了 33%。两个调查中，这些事件对健康和工作的影响感知相似，受伤受访者中寻求经济赔偿的法律诉讼比例也相似，分别为 11%（53/497）和 10.5%（41/391）。我们还报告了感知伤害率和严重程度、寻求和接受赔偿意愿的多变量分析结果。我们的研究结果表明，在这段时间内，以患者感知的医疗伤害为衡量标准，NHS 变得更加安全。我们的调查方法可以为监测与医疗保健相关的不良事件趋势以及患者安全计划的影响提供有价值的贡献。
