美国耶鲁纽黑文医院Harlan M. Krumholz团队联合美国卫生与公共服务部Noel Eldridge团队研究了美国2010-2019年住院患者不良事件发生率的趋势。相关论文于2022年7月12日发表在《美国医学会杂志》上。

患者安全是美国国家级优先事项，但缺乏对过去十年进展的全面评估。为了确定住院患者不良事件发生率的变化，研究组进行了一项系列横断面研究，使用2010-2019年医疗保险患者安全监测系统的数据来评估患者的院内不良事件。该研究包括2010-2019年间在美国3156家急诊医院住院的244542名成年患者，分为4组：急性心肌梗死（17%）、心力衰竭（17%）、肺炎（21%）和重大外科手术（22%）；以及2012-2019年因所有其他疾病住院的患者（22%）。

暴露因素为每个日历年期间住院的18岁及以上成年人。不良事件信息（从病历中提取）包括4个不良事件领域的21项措施：药物不良事件、医院获得性感染、手术后不良事件和一般不良事件（医院获得性压疮和跌倒）。结局为亚群中观察到的以及风险校正后的不良事件发生率随时间的总变化。

研究样本包括美国3156家急诊医院的190286名出院患者，他们分别为急性心肌梗死、心力衰竭、肺炎和接受重大外科手术（平均年龄68.0岁；52.6%为女性）；以及54256名包括所有其他情况（平均年龄57.7岁；59.8%为女性）的出院患者。

2010-2019年不良事件发生率总的变化为：急性心肌梗死每1000次出院后发生218次不良事件降至138次，心力衰竭每1000次出院后从168次降至116次，肺炎每1000次出院后从195次降至119次，重大外科手术每1000次出院后从204次降至130次。2012-2019年，所有其他情况下的不良事件发生率保持不变，为每1000例出院发生70例不良事件。

在对患者和医院特征进行校正后，急性心肌梗死患者每1000次出院中所有不良事件的相对风险年变化为0.94，心力衰竭为0.95，肺炎为0.94，重大外科手术为0.93，所有其他情况为0.97。在所有患者组中，药物不良事件、医院获得性感染和一般不良事件的风险校正后不良事件发生率显著下降。对于重大手术组的患者，手术后的风险校正不良事件发生率显著下降。

研究结果表明，2010-2019年，美国因急性心肌梗死、心力衰竭、肺炎和重大手术而入院患者的病历中提取的不良事件发生率显著下降，2012-2019年间所有其他情况下的校正后不良事件发生率亦显著下降。仍需进一步研究，以了解这些趋势在多大程度上代表了患者安全性的变化。

附：英文原文

Title: Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019

Author: Noel Eldridge, Yun Wang, Mark Metersky, Sheila Eckenrode, Jasie Mathew, Nancy Sonnenfeld, Jade Perdue-Puli, David Hunt, P. Jeffrey Brady, Paul McGann, Erin Grace, David Rodrick, Elizabeth Drye, Harlan M. Krumholz

Issue&Volume: 2022/07/12

Abstract:

Importance  Patient safety is a US national priority, yet lacks a comprehensive assessment of progress over the past decade.

Objective  To determine the change in the rate of adverse events in hospitalized patients.

Design, Setting, and Participants  This serial cross-sectional study used data from the Medicare Patient Safety Monitoring System from 2010 to 2019 to assess in-hospital adverse events in patients. The study included 244542 adult patients hospitalized in 3156 US acute care hospitals across 4 condition groups from 2010 through 2019: acute myocardial infarction (17%), heart failure (17%), pneumonia (21%), and major surgical procedures (22%); and patients hospitalized from 2012 through 2019 for all other conditions (22%).

Exposures  Adults aged 18 years or older hospitalized during each included calendar year.

Main Outcomes and Measures  Information on adverse events (abstracted from medical records) included 21 measures across 4 adverse event domains: adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events (hospital-acquired pressure ulcers and falls). The outcomes were the total change over time for the observed and risk-adjusted adverse event rates in the subpopulations.

Results  The study sample included 190286 hospital discharges combined in the 4 condition-based groups of acute myocardial infarction, heart failure, pneumonia, and major surgical procedures (mean age, 68.0 [SD, 15.9] years; 52.6% were female) and 54256 hospital discharges for the group including all other conditions (mean age, 57.7 [SD, 20.7] years; 59.8% were female) from 3156 acute care hospitals across the US. From 2010 to 2019, the total change was from 218 to 139 adverse events per 1000 discharges for acute myocardial infarction, from 168 to 116 adverse events per 1000 discharges for heart failure, from 195 to 119 adverse events per 1000 discharges for pneumonia, and from 204 to 130 adverse events per 1000 discharges for major surgical procedures. From 2012 to 2019, the rate of adverse events for all other conditions remained unchanged at 70 adverse events per 1000 discharges. After adjustment for patient and hospital characteristics, the annual change represented by relative risk in all adverse events per 1000 discharges was 0.94 (95% CI, 0.93-0.94) for acute myocardial infarction, 0.95 (95% CI, 0.94-0.96) for heart failure, 0.94 (95% CI, 0.93-0.95) for pneumonia, 0.93 (95% CI, 0.92-0.94) for major surgical procedures, and 0.97 (95% CI, 0.96-0.99) for all other conditions. The risk-adjusted adverse event rates declined significantly in all patient groups for adverse drug events, hospital-acquired infections, and general adverse events. For patients in the major surgical procedures group, the risk-adjusted rates of events after a procedure declined significantly.

Conclusions and Relevance  In the US between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions. Further research is needed to understand the extent to which these trends represent a change in patient safety.

DOI: 10.1001/jama.2022.9600

Source: https://jamanetwork.com/journals/jama/article-abstract/2794055