Self-reported adverse events in health care that cause harm: a population-based survey
Self-reported adverse events in health care that cause harm: a population-based survey
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DOI：
10.5694/j.1326-5377.2009.tb02523.x
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发表时间：
2009-05-04
影响因子：
11.4
通讯作者：
Ruffin, Richard E.
中科院分区：
文献类型：
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作者：
Adams, Robert J.;Tucker, Graeme;Ruffin, Richard E.
目的：确定社区居住成人卫生保健中自我报告的有害不良事件的发生率，并调查卫生系统中对安全的态度。设计：横断面、基于人群的调查。参与者和环境：对2004年和2005年参与西北阿德莱德健康研究第二阶段的3522名成年人的数据进行了分析。主要结局指标：自述过去一年内造成伤害的不良事件；对卫生保健安全的态度，包括目前预防不良事件的措施是否充分，以及患者本身、医生和政府等群体对患者安全的影响。结果：自述有害不良事件年发生率为4.2%。主要类型为用药错误（45.5%）和误诊错误治疗（25.6%）。多元logistic回归显示，自我报告的有害不良事件更可能发生在过去12个月内住院的人群中（比值比[OR]， 2.5; 95% Cl, 1.9-3.4）、年收入较低（< 1.2万美元）、完成高等教育至学士或更高学历的人群中（比值比[OR]， 3.0; 95% Cl, 1.0-9.4），以及对近期医疗保健有一定程度不满的人群中；而在那些更厌恶风险的人群中，这种可能性要低于那些有冒险行为倾向的人群（OR, 0.6; 95% Cl, 0.4-0.9）。与专业团体或政府相比，人们更有可能相信卫生保健专业人员个人对安全有积极影响，并且更多的资源是改善卫生保健安全的关键。结论：我们发现自我报告的有害不良事件发生率明显低于2002年澳大利亚调查的结果（4.2% vs 6.5%; P = 0.009）。更好的沟通，帮助患者获得更现实的风险认知，可能有助于减少伤害。更好的沟通还可以增加公众对改进安全系统的宣传，以反对社区坚持认为仅凭个人行动就能纠正这种情况的信念。
Objectives: To identify the incidence of self-reported harmful adverse events in the health care of community-dwelling adults, and to examine attitudes about safety in the health system.Design: Cross-sectional, population-based survey.Participants and setting: Analysis of data from 3522 adults participating in Stage 2 of the North West Adelaide Health Study, who were surveyed in 2004 and 2005.Main outcome measures: Self-reported adverse events causing harm in the past year; attitudes to safety in health care, including adequacy of current measures for preventing adverse events, and the effect of groups like patients themselves, doctors and governments on patient safety.Results: The annual incidence of self-reported harmful adverse events was 4.2%. The main types were medication error (45.5%) and misdiagnosis or wrong treatment (25.6%). Multiple logistic regression showed that self-reported harmful adverse events were more likely in people who had been hospitalised in the past 12 months (odds ratio [OR], 2.5; 95% Cl, 1.9-3.4), those who had low annual income (< $12 000), those who completed higher education to the level of Bachelor degree or higher (OR, 3.0; 95% Cl, 1.0-9.4), and those who had some level of dissatisfaction with their recent health care; and less likely in those more risk-averse rather than those with a tendency to risk-taking behaviour (OR, 0.6; 95% Cl, 0.4-0.9). People were more likely to believe that individual health care professionals had a positive effect on safety than professional groups or government, and that more resources were the key to improving the safety of health care.Conclusion: We found an incidence of self-reported harmful adverse events that was significantly lower than that found by a 2002 Australian survey (4.2% v 6.5%; P = 0.009). Better communication to help patients acquire more realistic risk perception may help reduce harm. Better communication could also increase public advocacy for systems improvement in safety to counter persisting community beliefs that individual action alone can redress the situation.