INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED-PATIENTS - RESULTS OF THE HARVARD MEDICAL-PRACTICE STUDY-I
INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED-PATIENTS - RESULTS OF THE HARVARD MEDICAL-PRACTICE STUDY-I
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DOI：
10.1056/nejm199102073240604
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发表时间：
1991-02-07
影响因子：
158.5
通讯作者：
HIATT, HH
中科院分区：
文献类型：
--
作者：
BRENNAN, TA;LEAPE, LL;HIATT, HH
背景 作为医疗伤害和医疗事故诉讼的跨学科研究的一部分，我们估计了不良事件的发生率，定义为医疗管理造成的伤害，以及由于疏忽或不合格的护理造成的此类伤害的亚组。 我们回顾了1984年从纽约州51家随机选择的急性护理、非精神病医院中随机选择的30，121份记录。 然后，我们根据患者的年龄和性别以及医生的专业制定了伤害的人口估计和计算率。 不良事件发生在3.7%的住院（95%置信区间，3.2至4.2），27.6%的不良事件是由于疏忽（95%置信区间，22.5至32.6）。 尽管70.5%的不良事件导致残疾持续时间不到6个月，但2.6%导致永久性残疾伤害，13.6%导致死亡。 在更严重的伤害类别中，可归因于疏忽的不良事件百分比增加（Wald检验卡方= 21.04，P < 0.0001）。 使用加权总数，我们估计1984年从纽约医院出院的2，671，863名患者中有98，609起不良事件，27，179起不良事件涉及疏忽。 不良事件发生率随年龄增长而上升（P < 0.0001）。 老年组因疏忽引起的不良事件发生率明显高于对照组（P < 0.01）。 不同临床专业的不良事件发生率差异有统计学意义（P < 0.0001），但因疏忽引起的不良事件发生率差异无统计学意义。 医疗管理对患者造成了大量伤害，许多伤害是不合格护理的结果。
Background. As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.Methods. We reviewed 30, 121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.Results. Adverse events occurred in 3.7 percent of the hospitalizations (95 percent confidence interval, 3.2 to 4.2), and 27.6 percent of the adverse events were due to negligence (95 percent confidence interval, 22.5 to 32.6). Although 70.5 percent of the adverse events gave rise to disability lasting less than six months, 2.6 percent caused permanently disabling injuries and 13.6 percent led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test chi-2 = 21.04, P < 0.0001). Using weighted totals, we estimated that among the 2,671,863 patients discharged from New York hospitals in 1984 there were 98,609 adverse events and 27,179 adverse events involving negligence. Rates of adverse events rose with age (P < 0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (P < 0.01). There were significant differences in rates of adverse events among categories of clinical specialties (P < 0.0001), but no differences in the percentage due to negligence.Conclusions. There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.