Rodwin Benjamin A, Bilan Victor P, Merchant Naseema B, Steffens Catherine G, Grimshaw Alyssa A, Bastian Lori A, Gunderson Craig G
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
VA Connecticut Healthcare System, West Haven, CT, USA.
J Gen Intern Med. 2020 Jul;35(7):2099-2106. doi: 10.1007/s11606-019-05592-5. Epub 2020 Jan 21.
The number of preventable inpatient deaths in the USA is commonly estimated as between 44,000 and 98,000 deaths annually. Because many inpatient deaths are believed to be preventable, mortality rates are used for quality measures and reimbursement. We aimed to estimate the proportion of inpatient deaths that are preventable.
A systematic literature search of Medline, Embase, Web of Science, and the Cochrane Library through April 8, 2019, was conducted. We included case series of adult patients who died in the hospital and were reviewed by physicians to determine if the death was preventable. Two reviewers independently performed data extraction and study quality assessment. The proportion of preventable deaths from individual studies was pooled using a random-effects model.
Sixteen studies met inclusion criteria. Eight studies of consecutive or randomly selected cohorts including 12,503 deaths were pooled. The pooled rate of preventable mortality was 3.1% (95% CI 2.2-4.1%). Two studies also reported rates of preventable mortality limited to patients expected to live longer than 3 months, ranging from 0.5 to 1.0%. In the USA, these estimates correspond to approximately 22,165 preventable deaths annually and 7150 deaths for patients with greater than 3-month life expectancy.
The number of deaths due to medical error is lower than previously reported and the majority occur in patients with less than 3-month life expectancy. The vast majority of hospital deaths are due to underlying disease. Our results have implications for the use of hospital mortality rates for quality reporting and reimbursement.
PROSPERO registration number CRD42018095140.
美国每年可预防的住院患者死亡人数通常估计在44000至98000人之间。由于许多住院患者死亡被认为是可预防的，死亡率被用于质量衡量和报销。我们旨在估计可预防的住院患者死亡比例。
通过检索截至2019年4月8日的Medline、Embase、科学引文索引和考科蓝图书馆进行系统的文献检索。我们纳入了在医院死亡的成年患者病例系列，并由医生进行审查以确定死亡是否可预防。两名审查员独立进行数据提取和研究质量评估。使用随机效应模型汇总个体研究中可预防死亡的比例。
16项研究符合纳入标准。汇总了8项关于连续或随机选择队列的研究，包括12503例死亡。可预防死亡率的汇总率为3.1%（95%置信区间2.2 - 4.1%）。两项研究还报告了仅限于预期寿命超过3个月患者的可预防死亡率，范围为0.5%至1.0%。在美国，这些估计数分别对应每年约22165例可预防死亡和预期寿命超过3个月患者的7150例死亡。
因医疗差错导致的死亡人数低于先前报告的数字，且大多数发生在预期寿命不足3个月的患者中。绝大多数医院死亡是由基础疾病导致的。我们的结果对将医院死亡率用于质量报告和报销具有启示意义。
国际前瞻性系统评价注册库注册号CRD42018095140。
