Centre for Health Policy, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia. Email:
Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia. Email:
Aust Health Rev. 2021 Mar;45(2):135-142. doi: 10.1071/AH20126.
Objective This study determined the economic impact of 16 'high-priority' hospital-acquired complications (HACs), as defined by the Australian Commission on Safety and Quality in Health Care, from the perspective of an individual Australian health service. Methods A retrospective cohort study was performed using a deidentified patient dataset containing 93056 in-patient separations in Northern Health (Victoria, Australia) from 1 July 2016 to 30 June 2017. Two log-linked generalised linear regression models were used to obtain additional costs and additional length of stay (LOS) for 16 different HACs, with the main outcome measures being the additional cost and LOS for all 16 HACs. Results In all, 1700 separations involving HACs (1.83%) were identified. The most common HAC was health care-associated infections. Most HACs were associated with a statistically significant risk of increased cost (15/16 HACs) and LOS (11/16 HACs). HACs involving falls resulting in fracture or other intracranial injury were associated with the highest additional cost (A$17173). The biggest increase in additional LOS was unplanned admissions to the intensive care unit (5.42 days). Conclusions This study shows the economic impact of HACs from the perspective of an individual health service. The methodology used demonstrates how other health services could determine safety priorities corresponding to their own casemix. What is known about the topic? HACs are a major issue in Australian health care; however, their effect on cost and LOS at the individual health service level is not well quantified. What does this paper add? Additional cost and LOS implications for 16 high-priority HACs have been quantified within an Australian health service. There is substantial variation in terms of the number of HACs and the economic impact of each HAC. What are the implications for practitioners? This study provides a template for other health services to assess the economic impact of HACs corresponding to their own casemix and to inform targeted patient safety programs.
目的 本研究从澳大利亚安全与质量卫生保健委员会（Australian Commission on Safety and Quality in Health Care）定义的 16 种“高优先级”医院获得性并发症（hospital-acquired complications，HACs）的角度，确定了个体澳大利亚卫生服务机构的经济影响。
方法 使用包含 93056 例 2016 年 7 月 1 日至 2017 年 6 月 30 日期间在维多利亚州北部卫生署（Northern Health）住院的患者的匿名数据集进行回顾性队列研究。使用双对数广义线性回归模型，获得 16 种不同 HAC 的额外成本和额外住院时间（length of stay，LOS），主要结局指标是所有 16 种 HAC 的额外成本和 LOS。
结果 共确定了 1700 例涉及 HAC 的分离（1.83%）。最常见的 HAC 是医源性感染。大多数 HAC 与成本增加（16 种 HAC 中有 15 种）和 LOS 增加（16 种 HAC 中有 11 种）有统计学意义的风险相关。涉及跌倒导致骨折或其他颅内损伤的 HAC 与最高的额外成本相关（17173 澳元）。额外 LOS 增加最多的是计划外转入重症监护病房（5.42 天）。
结论 本研究从个体卫生服务的角度展示了 HAC 的经济影响。所使用的方法表明，其他卫生服务机构可以如何确定与其自身病例组合相对应的安全优先级。
已知关于此主题的内容？
HAC 是澳大利亚卫生保健中的一个主要问题；然而，它们对个体卫生服务层面的成本和 LOS 的影响尚未得到充分量化。
本文增加了什么内容？
已在澳大利亚卫生服务机构内量化了 16 种高优先级 HAC 的额外成本和 LOS 影响。在 HAC 的数量和每个 HAC 的经济影响方面存在很大差异。
这对从业者意味着什么？
本研究为其他卫生服务机构提供了一个模板，以评估与自身病例组合相对应的 HAC 的经济影响，并为有针对性的患者安全计划提供信息。
