Kapoor Alok, Field Terry, Handler Steven, Fisher Kimberly, Saphirak Cassandra, Crawford Sybil, Fouayzi Hassan, Johnson Florence, Spenard Ann, Zhang Ning, Gurwitz Jerry H
Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
Meyers Primary Care Institute, Worcester, Massachusetts.
JAMA Intern Med. 2019 Sep 1;179(9):1254-1261. doi: 10.1001/jamainternmed.2019.2005.
Transition from hospital to nursing home is a high-risk period for adverse events in long-term care (LTC) residents. Adverse events include harms from medical care, including failure to provide appropriate care.
To report the incidence, type, severity, and preventability of adverse events in LTC residents transitioning from hospital back to the same LTC facility.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017, and followed up for 45 days. In a random sample of 32 nursing homes located in 6 New England states, 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility.
The main outcome was an adverse event within the 45-day period after transition from hospital back to nursing home. Trained nurse abstractors reviewed nursing home records for the period, and then 2 physicians independently reviewed each potential adverse event to determine whether harm occurred and to characterize the type, severity, and preventability of each event. When reviewers disagreed, they met to reach consensus.
Of the 555 individual residents, 365 (65.6%) were female, and the mean (SD) age at the time of discharge was 82.2 (11.5) years. Five hundred twenty (93.7%) were non-Hispanic white, 21 (3.8%) were non-Hispanic black, 9 (1.6%) were Hispanic, and 5 (0.9%) were of other non-Hispanic race/ethnicity. In the cohort, there were 379 adverse events among 762 discharges. One hundred ninety-seven events (52.0%) related to resident care, with pressure ulcers, skin tears, and falls with injury representing the most common types of events in this category. Health care-acquired infections (108 [28.5%]) and adverse drug events (64 [16.9%]) were the next most common. One hundred ninety-eight (52.2%) adverse events were characterized as less serious. However, 145 (38.3%) events were deemed serious, 28 (7.4%) life-threatening, and 8 (2.1%) fatal. In terms of preventability, 267 (70.4%) adverse events were found to be preventable or ameliorable, with less serious events more often considered preventable or ameliorable (146 [73.7%]) compared with more severe events (121 [66.9%]). In addition, resident care-related adverse events such as fall with injury, skin tear, and pressure ulcer were more commonly deemed preventable (173 of 197 [87.8%]) compared with adverse drug events (39 of 64 [60.9%]) or health care-acquired infections (49 of 108 [45.4%]).
Adverse events developed in nearly 4 of 10 of discharges from hospital back to LTC. Most were preventable or ameliorable. Standardized reporting of events and better coordination and information transfer across settings are potential ways to prevent adverse events in LTC residents.
从医院转至疗养院是长期护理（LTC）居民发生不良事件的高风险时期。不良事件包括医疗护理造成的伤害，如未能提供适当护理。
报告从医院转回同一LTC机构的LTC居民中不良事件的发生率、类型、严重程度和可预防性。
设计、设置和参与者：对2016年3月1日至2017年12月31日从医院出院后转回LTC的居民进行前瞻性队列研究，并随访45天。在位于新英格兰6个州的32家疗养院的随机样本中，选取了555名LTC居民，共有762次从医院转回同一LTC机构的情况。
主要结局是从医院转回疗养院后的45天内发生的不良事件。经过培训的护士摘要员查阅了该期间的疗养院记录，然后2名医生独立审查每起潜在不良事件，以确定是否发生伤害，并对每起事件的类型、严重程度和可预防性进行描述。当审查人员意见不一致时，他们会开会达成共识。
在555名居民中，365名（65.6%）为女性，出院时的平均（标准差）年龄为82.2（11.5）岁。520名（93.7%）为非西班牙裔白人，21名（3.8%）为非西班牙裔黑人，9名（1.
