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1.
JAMA ; 328(2): 173-183, 2022 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-35819424

RESUMO

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 244 542 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 190 286 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 54 256 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.


Assuntos
Hospitalização , Segurança do Paciente , Acidentes por Quedas/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/epidemiologia , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Masculino , Medicare/estatística & dados numéricos , Medicare/tendências , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Segurança do Paciente/estatística & dados numéricos , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Lesão por Pressão/epidemiologia , Medição de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos/epidemiologia
4.
MMWR Morb Mortal Wkly Rep ; 70(22): 825-829, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34081687

RESUMO

End-stage renal disease (ESRD) is a condition in which kidney function has permanently declined such that renal replacement therapy* is required to sustain life (1). The mortality rate for patients with ESRD in the United States has been declining since 2001 (2). However, during the COVID-19 pandemic, ESRD patients are at high risk for COVID-19-associated morbidity and mortality, which is due, in part, to weakened immune systems and presence of multiple comorbidities (3-5). The ESRD National Coordinating Center (ESRD NCC) supports the Centers for Medicare & Medicaid Services (CMS) and the ESRD Networks†,§ through analysis of data, dissemination of best practices, and creation of educational materials. ESRD NCC analyzed deaths reported to the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb), a system that facilitates the collection of data and maintenance of information about ESRD patients on chronic dialysis or receiving a kidney transplant who are treated in Medicare-certified dialysis facilities and kidney transplant centers in the United States. Excess death estimates were obtained by comparing observed and predicted monthly numbers of deaths during February 1-August 31, 2020; predicted deaths were modeled based on data from January 1, 2016, through December 31, 2019. The analysis estimated 8.7-12.9 excess deaths per 1,000 ESRD patients, or a total of 6,953-10,316 excess deaths in a population of 798,611 ESRD patients during February 1-August 31, 2020. These findings suggest that deaths among ESRD patients during the early phase of the pandemic exceeded those that would have been expected based on previous years' data. Geographic and temporal patterns of excess mortality, including those among persons with ESRD, should be considered during planning and implementation of interventions, such as COVID-19 vaccination, infection control guidance, and patient education. These findings underscore the importance of data-driven technical assistance and further analyses of the causes and patterns of excess deaths in ESRD patients.


Assuntos
Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Mortalidade/tendências , COVID-19/epidemiologia , COVID-19/mortalidade , Humanos , Medição de Risco , Estados Unidos/epidemiologia
9.
J Patient Saf ; 10(3): 125-32, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25119788

RESUMO

The Partnership for Patients, launched in April 2011, is a national quality improvement initiative from the Department of Health and Human Services that has set ambitious goals for U.S. providers to improve patient safety and care transitions. This paper outlines the initiative's measurement strategy, describing four measurement-related objectives: (1) to track national progress toward the program goals that U.S. hospitals reduce preventable adverse events by 40% and readmissions by 20%; (2) to support local quality improvement measurement in participating hospitals by providing the appropriate tools, training, and programmatic structure; (3) to obtain feedback on hospital and contractor progress, in close to real time, so the project can be effectively managed; and (4) to evaluate the program's impact on adverse event and readmission rates.


Assuntos
Hospitalização/estatística & dados numéricos , Segurança do Paciente/normas , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Hospitais/normas , Humanos , Erros Médicos/estatística & dados numéricos , Medicare , Readmissão do Paciente/estatística & dados numéricos , Desenvolvimento de Programas , Gestão da Segurança , Estados Unidos
11.
J Am Geriatr Soc ; 55(10): 1663-9, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17714457

RESUMO

The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care.


Assuntos
Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/tendências , Humanos , Lesão por Pressão/classificação , Lesão por Pressão/prevenção & controle , Prevalência , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
12.
Ann Intern Med ; 145(5): 342-53, 2006 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-16908911

RESUMO

BACKGROUND: Studies have shown improvement in quality of health care in the United States. However, the factors responsible for this improvement are largely unknown. OBJECTIVE: To evaluate the effect of the Medicare Quality Improvement Organization (QIO) Program in 4 clinical settings by using performance data for 41 quality measures during the 7th Scope of Work. DESIGN: Observational study in which differences in quality measures were compared between baseline and remeasurement periods for providers that received different levels of QIO interventions. SETTING: Nursing homes, home health agencies, hospitals, and physician offices in the 50 U.S. states, the District of Columbia, and 2 U.S. territories. PARTICIPANTS: Providers receiving focused QIO assistance related to quality measures and providers receiving general informational assistance from QIOs. MEASUREMENTS: 5 nursing home quality measures, 11 home health measures, 21 hospital measures, and 4 physician office measures. RESULTS: For nursing home, home health, and physician office measures, providers recruited specifically by QIOs for receipt of assistance showed greater improvement in performance on 18 of 20 measures than did providers who were not recruited; similar improvement was seen on the other 2 measures. Nursing homes and home health agencies improved more in all measures on which they chose to work with the QIO than in other measures. Nineteen of 21 hospital measures showed improvement; in this setting, QIOs were contracted for improvement initiatives solely at the statewide level. Overall, improvement was seen in 34 of 41 measures from baseline to remeasurement in the 7th Scope of Work. LIMITATIONS: As in any observational study, selection bias, regression to the mean, and secular trends may have influenced the results. CONCLUSIONS: These findings are consistent with an impact of the QIO Program and QIO technical assistance on the observed improvement. Future evaluations of the QIO Program will attempt to better address the limitations of the design of this study.


Assuntos
Agências de Assistência Domiciliar/normas , Medicare/normas , Indicadores de Qualidade em Assistência à Saúde , Serviços Médicos de Emergência/normas , Serviços de Saúde/normas , Hospitais/normas , Casas de Saúde/normas , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/normas , Avaliação de Programas e Projetos de Saúde , Estados Unidos
13.
J Nurs Scholarsh ; 35(2): 133-7, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12854293

RESUMO

PURPOSE: To compare three published short GDS scales and to identify a valid and reliable short-form alternative to the 15-item Geriatric Depression Scale. DESIGN: Comparative validation study via retrospective chart review of 816 acute care patients in an 830-bed academic medical center in the USA in 2001. METHODS: Data of the 15-item Geriatric Depression Scale, the Mini-Mental State Examination, and demographic data were extracted from medical records after patient discharge. Three scales: the D'Ath GDS-4, van Marwijk GDS-4, and Hoyl GDS-5, were compared to the 15-item Geriatric Depression Scale. RESULTS: The Hoyl 5-item version showed the highest sensitivity (97.9%). Concern for GDS-5 false positives when compared to the 15-item GDS (specificity 72.7%) led to re-ordering the 15 GDS items into a new two-tiered instrument, the GDS-5/15. In this study of 816 older adult inpatients, 60% were screened as "not depressed" using the first 5 items on the GDS-5/15, leaving 40% for continued screening and completion of all 15 GDS items. CONCLUSIONS: A shorter screening tool might encourage more providers to add depression screening to routine health care visits. The GDS-5/15 is an alternative screening tool.


Assuntos
Transtorno Depressivo/diagnóstico , Avaliação Geriátrica , Escalas de Graduação Psiquiátrica/normas , Centros Médicos Acadêmicos , Idoso , Feminino , Humanos , Pacientes Internados , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , North Carolina , Avaliação em Enfermagem/métodos , Avaliação em Enfermagem/normas , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo
14.
J Am Geriatr Soc ; 51(7): 979-84, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12834518

RESUMO

OBJECTIVES: To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence (UI). DESIGN: Group randomized trial, conducted from 1996 to 1997. SETTING: Internal medicine and family medicine community practices. PARTICIPANTS: Forty-one primary care practices, including 57 physicians and their staff and 1,145 patients aged 60 and older. INTERVENTION: Twenty of the 41 primary care practices in North Carolina were randomized to a composite intervention that included a 3-hour continuing medical education accredited course, training in management of UI, patient educational materials, and on-site physician and office support. The remaining 21 practices served as "usual care" controls. Telephone surveys of UI status and quality of life were obtained from 1,145 patients before the intervention. At 1 year, patients and physicians were contacted by telephone and mail to determine the effect of the educational intervention. MEASUREMENTS: Patients completed telephone surveys to assess screening for UI, UI status, treatment interventions, and quality of life. Physicians completed surveys related to UI treatment and practice patterns. RESULTS: Baseline and endpoint telephone surveys were completed by 668 of 1,145 (58%) of patients, who were cared for by 45 physicians (10 internists, 35 family medicine). Physician screening rates for UI were 22% for those patients who did not report UI. UI was reported by 39.5% of patients at baseline, of whom 30% reported being asked about UI by their primary care physician during the study. Rates of assessment and management of existing UI were low in both the control and intervention groups. Additional historical questioning indicated that 54.2% reported that they had ever undergone assessment, including history, urinalysis, or testing, or had had management of their UI by any physician. CONCLUSION: Attempts at increasing screening and management of UI by primary care physicians using the AHCPR standardized guidelines using a multifaceted system of educational and logistical support were not successful. These guidelines may not be the best approach to treating UI in the primary care setting.


Assuntos
Implementação de Plano de Saúde/normas , Programas de Rastreamento/normas , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , United States Agency for Healthcare Research and Quality/normas , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisas sobre Atenção à Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Distribuição Aleatória , Estados Unidos
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