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January 22, 2014New England Journal of MedicineOpen Access

National Trends in Patient Safety for Four Common Conditions, 2005–2011

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Population

61,523 Medicare patients hospitalized in the United States between 2005 and 2011 for acute myocardial…

Design

Cohort

Follow-up

hospitalization

Key result

Between 2005 and 2011, adverse-event rates declined among Medicare patients hospitalized for acute myocardial infarction (5.0% to 3.7%) and congestive heart failure (3.7% to 2.7%).

Authors

YWYun WangNENoel EldridgeMMMark L. Metersky

Discussion

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Overview

May indicate cardiac inpatient safety progress; observational data leave causality and broader applicability open.

Key Points

  • To assess national trends in hospital-acquired adverse events among Medicare patients hospitalized for four common medical and surgical conditions between 2005 and 2011.
  • Analyzed medical record data from the Medicare Patient Safety Monitoring System for 61,523 patients hospitalized in the United States between 2005 and 2011.
  • Tracked 21 adverse events among patients with acute myocardial infarction (19%), congestive heart failure (25%), pneumonia (30%), and conditions requiring surgery (27%).
  • In acute myocardial infarction, the adverse-event rate declined from 5.0% to 3.7% (difference, 1.3 percentage points; 95% CI, 0.7 to 1.9) and adverse events per 1000 hospitalizations dropped from 401.9 to 262.2 (difference, 139.7; 95% CI, 90.6 to 189.0).
  • In congestive heart failure, the adverse-event rate decreased from 3.7% to 2.7% (difference, 1.0 percentage points; 95% CI, 0.5 to 1.4) and adverse events per 1000 hospitalizations fell from 235.2 to 166.9 (difference, 68.3; 95% CI, 39.9 to 96.7).
  • Patients hospitalized for pneumonia and conditions requiring surgery exhibited no statistically significant declines in adverse-event rates over the study period.

Study Design

Type

Observational (n=61,523)

Multicenter

Yes

Structured PICO

P
Population
61,523 Medicare patients hospitalized in the United States between 2005 and 2011 for acute myocardial infarction (19%), congestive heart failure (25%), pneumonia (30%), or conditions requiring surgery (27%).
O
Outcome
Rate of occurrence of 21 adverse events, proportion of patients with one or more adverse events, and number of adverse events per 1000 hospitalizationssafety

Main Result

Effect estimate: difference 1.3 percentage points (95% CI 0.7 to 1.9)

Absolute Event Rate: 3.7% vs 5%

Patient safety and adverse event rates improved significantly for Medicare patients hospitalized with AMI or CHF between 2005 and 2011, but not for those with pneumonia or surgical conditions.

Cite This Study

Wang et al. (2014) conducted an observational in Acute myocardial infarction, congestive heart failure, pneumonia, or conditions requiring surgery (n=61,523). Hospitalization in 2011 vs. Hospitalization in 2005 was evaluated on Rate of occurrence of adverse events among patients with acute myocardial infarction (difference 1.3 percentage points, 95% CI 0.7 to 1.9). Between 2005 and 2011, adverse-event rates declined among Medicare patients hospitalized for acute myocardial infarction (5.0% to 3.7%) and congestive heart failure (3.7% to 2.7%).

synapsesocial.com/papers/6a15507a814bf8ec9a4e6610https://doi.org/10.1056/nejmsa1300991
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