Stockwell David C, Landrigan Christopher P, Toomey Sara L, Westfall Matthew Y, Liu Shanshan, Parry Gareth, Coopersmith Ari S, Schuster Mark A
Children's National Medical Center, Washington, District of Columbia.
Division of Critical Care Medicine, Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia.
Hosp Pediatr. 2019 Jan;9(1):1-5. doi: 10.1542/hpeds.2018-0131. Epub 2018 Dec 3.
Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool.
GAPPS was applied to medical records of randomly selected pediatric patients discharged from 16 hospitals in the Pediatric Research in Inpatient Settings Network across 4 US regions from January 2007 to December 2012. Disparities in AEs for hospitalized children were identified on the basis of patient race/ethnicity (black, Latino, white, or other; = 17 336 patient days) and insurance status (public, private, or self-pay/no insurance; = 19 030 patient days).
Compared with hospitalized non-Latino white children, hospitalized Latino children experienced higher rates of all AEs (Latino: 30.1 AEs per 1000 patient days versus white: 16.9 AEs per 1000 patient days; ≤ .001), preventable AEs (Latino: 15.9 AEs per 1000 patient days versus white: 8.9 AEs per 1000 patient days; = .002), and high-severity AEs (Latino: 12.6 AEs per 1000 patient days versus white: 7.7 AEs per 1000 patient days; = .02). Compared with privately insured children, publicly insured children experienced higher rates of preventable AEs (public: 12.1 AEs per 1000 patient days versus private: 8.5 AEs per 1000 patient days; = .02). No significant differences were observed among other groups.
The GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings. Further investigation may reveal underlying mechanisms of these disparities and could help hospitals reduce harm.
既往研究揭示了医疗质量和患者安全方面的种族/族裔及社会经济差异。然而，尚未采用临床确诊不良事件（AE）指标在儿科住院环境中对这些差异进行研究。在本研究中，我们使用全球儿科患者安全评估（GAPPS）触发工具进行了此项研究。
将GAPPS应用于2007年1月至2012年12月期间从美国4个地区的住院儿科研究网络中16家医院随机选取的出院儿科患者的病历。根据患者的种族/族裔（黑人、拉丁裔、白人或其他；共17336个患者日）和保险状况（公共保险、私人保险或自费/无保险；共19030个患者日）确定住院儿童不良事件的差异。
与住院的非拉丁裔白人儿童相比，住院的拉丁裔儿童发生的所有不良事件发生率更高（拉丁裔：每1000个患者日30.1例不良事件，白人：每1000个患者日16.9例不良事件；P≤.001），可预防不良事件发生率更高（拉丁裔：每1000个患者日15.9例不良事件，白人：每1000个患者日8.9例不良事件；P=.002），以及高严重度不良事件发生率更高（拉丁裔：每1000个患者日12.6例不良事件，白人：每1000个患者日7.7例不良事件；P=.02）。与有私人保险的儿童相比，有公共保险的儿童发生可预防不良事件的发生率更高（公共保险：每1000个患者日12.1例不良事件，私人保险：每1000个患者日8.5例不良事件；P=.02）。在其他组之间未观察到显著差异。
GAPPS分析揭示了在广泛的地理和医院环境中住院儿童不良事件发生率存在种族和/或族裔及社会经济差异。进一步调查可能揭示这些差异的潜在机制，并有助于医院减少伤害。
