Bernard D, Encinosa W; AcademyHealth. Meeting (2004 : San Diego, Calif.).

Abstr AcademyHealth Meet. 2004; 21: abstract no. 1908.

AHRQ, CFACT, 540 Gaither Road, Rockville, MD 20850 Tel. 301.427.1682 Fax 301.427.1276

RESEARCH OBJECTIVE: Most people think that patient safety events are isolated. While it is known that adverse patient safety events result in longer lengths of stay, it is not known whether they lead to excess risk of readmissions and whether they have an effect on patient outcomes following discharge. We examine long-term costs and patient outcomes associated with potentially preventable adverse medical events: costs of subsequent hospitalizations within 30 days after the initial index admission, probability of readmissions, probability of in-hospital death within 30 days after discharge, and probability of discharge to long-term care facility for major surgery patients. STUDY DESIGN: The newly-released AHRQ Patient Safety Indicators (2003) were used to identify 14 types of potentially preventable adverse events among major surgery patients. The data source is the Healthcare Cost and Utilization Project, State Inpatient Database for Florida. Audited hospital cost reports from the Florida Agency for Health Care Administration were used to compute hospital costs. For each major surgery index admission, we constructed hospital cost measures based on the index admission as well as hospital readmissions within 30 days of discharge following major surgery. We then conducted multivariate regression analyses, controlling for market characteristics, hospital characteristics and the patients risk of adverse outcomes, to predict the hospital costs attributable to the potentially preventable adverse medical event, as well as to predict the excess risk of readmission, excess risk of discharge to a long-term care facility, and excess risk of in-hospital death within 30 days after discharge. POPULATION STUDIED: The population is all elderly Medicare major surgery patients discharged from general acute-care hospitals in Florida in 1995 and 1996. Unique patient identifiers in this data enable us to examine readmissions. PRINCIPAL FINDINGS: Out of 195,049 adult major surgery discharges, 2.8 percent experienced at least one of the 14 potentially preventable adverse medical events. Of those patients with such patient safety events, 14.3 percent died in the hospital, 17.8 percent were readmitted within 30 days after discharge, and 22.5 percent were discharged to a long-term care facility. Mean hospital costs for index hospitalizations for patients with adverse medical events were $19,391 versus $9,253 for patients who did not have adverse medical events. Total hospital costs for the index hospitalization and 30 day readmissions for patients who had a potentially preventable adverse medical event were $21,176 versus $10,359 for patients who did not have adverse medical events. Controlling for covariates, we estimate that 65 percent of this difference ($7,010) was attributable to the adverse patient safety event. Among patients who did not die during the index admission, those who had potentially preventable adverse medical events were 34 percent more likely to be readmitted within 30 days following discharge. Patients who had potentially preventable adverse medical events were twice as likely to die during a readmission within 30 days following discharge. Patients who had potentially preventable adverse medical events were 32 percent more likely to be discharged to a long-term care facility following the index admission. CONCLUSIONS: The excess costs and adverse outcomes of potentially preventable adverse patient safety events continue to occur even after a patient leaves the hospital. Controlling for covariates, we estimate that total hospital costs within 30 days of index admission are 67 percent higher for patients who experience potentially preventable adverse medical events ($17,460) compared to patients who do not experience such events ($10,450). IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: A reduction in adverse patient safety events would not only improve quality of care and reduce Medicare's cost for that hospitalization but also reduce costs of readmissions and long-term care.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Aged
• Costs and Cost Analysis
• Diagnostic Errors
• Florida
• Health Care Costs
• Hospital Costs
• Hospitalization
• Hospitals
• Humans
• Patient Discharge
• Patient Readmission
• economics
• therapy
• hsrmtgs

UI: 103624942

From Meeting Abstracts