Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Xingning Road 57, Yinzhou District, Ningbo, 315000, China.
School of Public Health, Wannan Medical College, Wuhu, China.
Sci Rep. 2024 Aug 5;14(1):18114. doi: 10.1038/s41598-024-69283-w.
Adverse events (AEs) are a significant concern for healthcare systems. However, it is difficult to evaluate their influence because of the complexity of various medical services. This study aimed to assess the influence of AEs on the outcomes of hospitalized patients using a diagnosis-related group (DRG) database. We conducted a case-control study of hospitalized patients at a multi-district tertiary hospital with 2200 beds in China, using data from a DRG database. An AE refers to an unintended physical injury caused or contributed to by medical care that requires additional hospitalization, monitoring, treatment, or even death. Relative weight (RW), a specific indicator of DRG, was used to measure the difficulty of diagnosis and treatment, disease severity, and medical resources utilized. The primary outcomes were hospital length of stay (LOS) and hospitalization costs. The secondary outcome was discharge to home. This study applied DRG-based matching, Hodges-Lehmann estimate, regression analysis, and subgroup analysis to evaluate the influence of AEs on outcomes. Two sensitivity analyses by excluding short LOS and changing adjustment factors were performed to assess the robustness of the results. We identified 2690 hospitalized patients who had been divided into 329 DRGs, including 1345 patients who experienced AEs (case group) and 1345 DRG-matched normal controls. The Hodges-Lehmann estimate and generalized linear regression analysis showed AEs led to prolonged LOS (unadjusted difference, 7 days, 95% confidence interval [CI] 6-8 days; adjusted difference, 8.31 days, 95% CI 7.16-9.52 days) and excess hospitalization costs (unadjusted difference, $2186.40, 95% CI: $1836.87-$2559.16; adjusted difference, $2822.67, 95% CI: $2351.25-$3334.88). Logistic regression analysis showed AEs were associated with lower odds of discharge to home (unadjusted odds ratio [OR] 0.66, 95% CI 0.54-0.82; adjusted OR 0.75, 95% CI 0.61-0.93). The subgroup analyses showed that the results for each subgroup were largely consistent. LOS and hospitalization costs increased significantly after AEs in complex diseases (RW ≥ 2) and in relation to high degrees of harm subgroups (moderate harm and above groups). Similar results were obtained in sensitivity analyses. The burden of AEs, especially those related to complex diseases and severe harm, is significant in China. The DRG database serves as a valuable source of information that can be utilized for the evaluation and management of AEs.
不良事件（Adverse events，AEs）是医疗体系关注的重点。但是，由于各种医疗服务的复杂性，评估它们的影响非常困难。本研究旨在使用诊断相关组（Diagnosis-related group，DRG）数据库评估 AEs 对住院患者结局的影响。我们在中国一家拥有 2200 张床位的多地区三级医院进行了一项病例对照研究，该研究使用了 DRG 数据库中的数据。AE 是指由医疗护理引起或促成的意外身体伤害，需要额外的住院、监测、治疗，甚至死亡。相对权重（Relative weight，RW）是一种特定的 DRG 指标，用于衡量诊断和治疗的难度、疾病严重程度以及使用的医疗资源。主要结局指标为住院时间（Length of stay，LOS）和住院费用。次要结局指标为出院回家。本研究采用基于 DRG 的匹配、霍奇斯-莱曼估计、回归分析和亚组分析来评估 AEs 对结局的影响。通过排除 LOS 较短和改变调整因素进行了两次敏感性分析，以评估结果的稳健性。我们共确定了 2690 名住院患者，他们被分为 329 个 DRG，其中 1345 名患者发生了 AEs（病例组），1345 名患者与正常对照组匹配。霍奇斯-莱曼估计和广义线性回归分析表明，AEs 导致 LOS 延长（未经调整的差异为 7 天，95%置信区间 [CI] 为 6-8 天；经调整的差异为 8.31 天，95%CI 为 7.16-9.52 天）和住院费用增加（未经调整的差异为$2186.40，95%CI：$1836.87-$2559.16；经调整的差异为$2822.67，95%CI：$2351.25-$3334.88）。Logistic 回归分析表明，AEs 与出院回家的可能性降低相关（未经调整的比值比 [OR] 为 0.66，95%CI 为 0.54-0.82；经调整的 OR 为 0.75，95%CI 为 0.61-0.93）。亚组分析表明，在复杂疾病（RW≥2）和伤害程度较高的亚组（中度伤害及以上组）中，AE 后 LOS 和住院费用显著增加。敏感性分析也得到了类似的结果。在中国，AE 尤其是与复杂疾病和严重伤害相关的 AE 负担很大。DRG 数据库是评估和管理 AEs 的宝贵信息来源。
