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导致伤害的用药错误:利用收费主数据确定与住院费用和住院时间的关联

Medication errors resulting in harm: Using chargemaster data to determine association with cost of hospitalization and length of stay.

作者信息

McCarthy Bryan C, Tuiskula Kristin A, Driscoll Tara P, Davis Andrew M

机构信息

University of Chicago Medicine, Chicago, IL

Pharmacy Department, Massachusetts General Hospital, Boston, MA.

出版信息

Am J Health Syst Pharm. 2017 Dec 1;74(23 Supplement 4):S102-S107. doi: 10.2146/ajhp160848.

DOI:10.2146/ajhp160848
PMID:29167147
Abstract

PURPOSE

Results of an analysis of the economic impact of adverse drug events (ADEs) resulting in patient harm on hospitalization costs and length of stay (LOS) are reported.

METHODS

In a retrospective single-site study, medication errors among patients admitted to an academic medical center during the period April 2014-May 2015 were identified using voluntary event reporting system data and diagnosis codes. Hospitalization cases involving documented ADEs resulting in harm, as defined on a widely used medication error classification index, were matched with control cases by admission period, diagnosis-related group, and patient age and sex. Total hospitalization costs and LOS in the study groups were analyzed using an independent 2-sample Mann-Whitney test.

RESULTS

Among 416 hospitalization cases evaluated for inclusion in the study, 242 were matched with 3,279 control cases for analysis. The primary drug classes implicated in the evaluated medication errors included chemotherapy agents (38%), corticosteroids (14%), and opioids (11%). Total hospitalization costs differed significantly ( = 0.044) between patients who experienced ADEs resulting in harm (median, $19,444; interquartile range [IQR], $13,481-$40,580) and those who did not (median, $17,173; IQR, $12,500-$27,125); the former group also had a significantly ( = 0.005) longer median LOS.

CONCLUSION

Chargemaster data for an academic medical center revealed that the median total hospitalization cost and LOS were significantly greater for hospitalizations during which a harm-causing medication error was recorded versus hospitalizations during which harm-causing medication errors were not recorded.

摘要

目的

报告对导致患者伤害的药物不良事件(ADEs)对住院费用和住院时间(LOS)的经济影响的分析结果。

方法

在一项回顾性单中心研究中,利用自愿事件报告系统数据和诊断编码,识别2014年4月至2015年5月期间入住一所学术医疗中心的患者中的用药错误。根据广泛使用的用药错误分类指数定义,将涉及记录在案且导致伤害的ADEs的住院病例,按入院时间、诊断相关组、患者年龄和性别与对照病例进行匹配。使用独立样本曼-惠特尼检验分析研究组的总住院费用和住院时间。

结果

在评估纳入研究的416例住院病例中,242例与3279例对照病例匹配进行分析。评估的用药错误中涉及的主要药物类别包括化疗药物(38%)、皮质类固醇(14%)和阿片类药物(11%)。发生导致伤害的ADEs的患者(中位数为19,444美元;四分位间距[IQR]为13,481 - 40,580美元)与未发生的患者(中位数为17,173美元;IQR为12,500 - 27,125美元)之间的总住院费用存在显著差异(P = 0.044);前一组的中位住院时间也显著更长(P = 0.005)。

结论

一所学术医疗中心的收费主数据显示,记录到导致伤害的用药错误的住院病例的总住院费用中位数和住院时间,显著高于未记录到导致伤害的用药错误的住院病例。

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