The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.
The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.
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DOI：
10.1097/00132586-199802000-00016
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发表时间：
1998-02
期刊：
影响因子：
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通讯作者：
D. Bates;N. Spell;D. Cullen;E. Burdick;N. Laird;L. Petersen;S. Small;B. Sweitzer;L. Leape
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文献类型：
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作者：
D. Bates;N. Spell;D. Cullen;E. Burdick;N. Laird;L. Petersen;S. Small;B. Sweitzer;L. Leape
目的评估与药品不良事件（ADE）相关的额外资源利用。设计前瞻性队列研究中的巢式病例对照研究。参与者该队列包括4108名住院患者，在6个月期间，分层随机抽样，在2家三级医院的11个内科和外科单位。病例为ADE患者，每例病例的对照为与事件前住院时间最相似的病例在同一单位的患者。主要观察指标：术后住院时间及总费用。方法通过护士和药剂师的自我报告和每日病历回顾来检测事件，并根据它们是否代表ADE进行分类。住院时间和费用的信息来自账单数据，通过将费用乘以医院特定的费用与费用比率来估计费用。结果在研究期间，207例住院患者中有247例发生ADE。在排除离群值和多次发作后，有190起ADE，其中60起是可以预防的。在配对回归分析中调整了多个因素，包括严重程度、合并症和病例组合，与ADE相关的额外住院时间为2.2天（P=.04），与ADE相关的费用增加为3244美元（P=.04）。对于可预防的ADE，住院时间增加了4.6天（P= 0.03），总费用增加了5857美元（P= 0.07）。调整我们的抽样策略后，估计事件后的成本归因于ADE是2595美元的所有ADE和4685美元的可预防的ADE。根据这些成本和有关ADE发生率的数据，我们估计，对于一家拥有700张床位的教学医院，所有ADE和可预防的ADE的年度成本分别为560万美元和280万美元。结论：ADE给医院带来的巨大成本证明了预防这些事件的投资是合理的。此外，这些估计是保守的，因为它们不包括病人受伤或医疗事故的费用。
OBJECTIVE To assess the additional resource utilization associated with an adverse drug event (ADE). DESIGN Nested case-control study within a prospective cohort study. PARTICIPANTS The cohort included 4108 admissions to a stratified random sample of 11 medical and surgical units in 2 tertiary-care hospitals over a 6-month period. Cases were patients with an ADE, and the control for each case was the patient on the same unit as the case with the most similar pre-event length of stay. MAIN OUTCOME MEASURES Postevent length of stay and total costs. METHODS Incidents were detected by self-report stimulated by nurses and pharmacists and by daily chart review, and were classified as to whether they represented ADEs. Information on length of stay and charges was obtained from billing data, and costs were estimated by multiplying components of charges times hospital-specific ratios of costs to charges. RESULTS During the study period, there were 247 ADEs among 207 admissions. After outliers and multiple episodes were excluded, there were 190 ADEs, of which 60 were preventable. In paired regression analyses adjusting for multiple factors, including severity, comorbidity, and case mix, the additional length of stay associated with an ADE was 2.2 days (P=.04), and the increase in cost associated with an ADE was $3244 (P=.04). For preventable ADEs, the increases were 4.6 days in length of stay (P=.03) and $5857 in total cost (P=.07). After adjusting for our sampling strategy, the estimated postevent costs attributable to an ADE were $2595 for all ADEs and $4685 for preventable ADEs. Based on these costs and data about the incidence of ADEs, we estimate that the annual costs attributable to all ADEs and preventable ADEs for a 700-bed teaching hospital are $5.6 million and $2.8 million, respectively. CONCLUSIONS The substantial costs of ADEs to hospitals justify investment in efforts to prevent these events. Moreover, these estimates are conservative because they do not include the costs of injuries to patients or malpractice costs.