Difference in Patient Safety Events between Inpatients with and without Dementia: The Role of Hospitals

• Main Authors: Wan-Ju Hsieh, 謝宛如
• Other Authors: Nicole Huang
• Format: Others
• Language: en_US
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/t7mphv

碩士 === 國立陽明大學 === 醫務管理研究所 === 105 === Background Patient safety has been one major focus in health care system. Many speculate that patients with multiple chronic conditions, particularly those who are cognitively impaired, may be more susceptible to potential patient safety events. Sequels of dementia may hinder people from appropriately expressing their needs, adhering to medical or care instruction during hospitalization, and communicating with care providers. Previous studies showed that patients with dementia faced a higher risk of mortality, length of stay, and institutionalization, but the understanding of preventable adverse events among inpatients with dementia is very limited. Furthermore, it may be also important to explore, if the differences in patient safety do exist between patients with and without dementia, whether such differences may vary by hospital characteristics. Objectives We compared patient safety risk between patients with and without dementia, and explore whether the differences in patient safety risk varied by hospital ownership and accreditation level. Method This was a population-based pooled cross-section study and data was compiled over four years (2010-2013). The 2010-2013 National Health Insurance inpatient claims data were analyzed. From 2010 to 2013, we identified 4,233,235 inpatients admissions at risk for patient safety events that defined by Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSIs, version 5.0). A total of 77,215 inpatients with dementia and 4,156,020 inpatient without dementia aged 60 years or older were enrolled. In order to increase comparability, we used propensity score matching that matched the two groups of patients at 1:1 ratio by patient demographic characteristics. A 30-day period was used to define an inpatient episode. Any hospitalization occurs within the 30 days following the index admission was considered as a readmission. There were 124,828 episodes in the final sample. We applied multilevel model to control for physician clusters, to determine independent impacts of dementia on total, medical/surgical-related, surgical-related, and pressure ulcer adverse events. Results During the study period (2010-2013), the prevalence of any PSI event was 4.76‰. More specifically, the prevalence of medical/surgical and surgical-related PSI events were 0.72‰ and 9.23‰, respectively. The most commonly observed PSI among dementia patients during hospitalization were pressure ulcer (30.39‰), postoperative hip fracture (4.22‰), and postoperative pulmonary embolism or deep vein thrombosis (2.51‰). Although patients with dementia had a lower risk of incurring any PSI event than those without dementia (OR=0.83, 95% CI 0.67-1.02), they were at a significantly higher risk to incur pressure ulcer events than those without dementia (OR=2.22, 95% CI 2.01-2.46). A significant interaction was found between dementia status and hospital accreditation level. Patient safety risks were consistently high for both patients with and without dementia in district hospitals. Although patient safety risks were lower in medical centers and regional hospitals, the differences in patient safety risk between patients with and without dementia in medical centers and regional hospitals were significant. While hospitalized, dementia patients who cared in district hospitals were more likely to suffer from patient safety events. Conclusions This study indicated that patient safety events were relatively prevalent in hospitalized patients. Patients with dementia were less likely than general patients aged 60 and older to suffer from patient safety events except for pressure ulcer (PSI 03). The differences of pressure ulcer events between patients with and without dementia may vary across hospitals. The results may help to identify possible areas for inpatient care improvement. Additional work is necessary to explore the mechanisms underlying these findings in order to devise more specific and effective preventive strategies to reduce patient safety events such as pressure ulcer. Also, pondering what is the ideal medical care that integrated the physical and cognitive illnesses for the elderly is a top priority.