Patient Co-Morbidity and Functional Status Influence the Occurrence of Hospital Acquired Conditions More Strongly than Hospital Factors
| Autor: | Moghadamyeghaneh, Z, Stamos, MJ, Stewart, L |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Health Status Iatrogenic Disease Clinical Sciences Comorbidity Medicare Databases Risk Factors Clinical Research Hospital-acquired conditions Diabetes Mellitus 80 and over Humans Neoplasm Metastasis Digestive System Surgical Procedures Factual Aged Quality of Health Care Paraplegia Medical Errors Incidence Age Factors Functional status Length of Stay Middle Aged Foreign Bodies Hospital Charges Hospitals United States Gastrointestinal surgery Hospital factors Catheter-Related Infections Urinary Tract Infections Female Surgery |
| Zdroj: | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, vol 23, iss 1 Moghadamyeghaneh, Z; Stamos, MJ; & Stewart, L. (2018). Patient Co-Morbidity and Functional Status Influence the Occurrence of Hospital Acquired Conditions More Strongly than Hospital Factors. Journal of Gastrointestinal Surgery. doi: 10.1007/s11605-018-3957-9. UC Irvine: Retrieved from: http://www.escholarship.org/uc/item/4qb9h0ks |
| DOI: | 10.1007/s11605-018-3957-9. |
| Popis: | © 2018, The Society for Surgery of the Alimentary Tract. Background: Never events (NE) and hospital-acquired conditions (HAC) are used by Medicare/Medicaid Services to define hospital performance measures that dictate payments/penalties. Pre-op patient comorbidity may significantly influence HAC development. Methods: We studied 8,118,615 patients from the NIS database (2002–2012) who underwent upper/lower gastrointestinal and/or hepatopancreatobiliary procedures. Multivariate analysis, using logistic regression, was used to identify HAC and NE risk factors. Results: A total of 63,762 (0.8%) HAC events and 1645 (0.02%) NE were reported. A total of 99.9% of NE were retained foreign body. Most frequent HAC were: pressure ulcer stage III/IV (36.7%), poor glycemic control (26.9%), vascular catheter-associated infection (20.3%), and catheter-associated urinary tract infection (13.7%). Factors correlating with HAC included: open surgical approach (AOR: 1.25, P < 0.01), high-risk patients with significant comorbidity [severe loss function pre-op (AOR: 6.65, P < 0.01), diabetes with complications (AOR: 2.40, P < 0.01), paraplegia (AOR: 3.14, P < 0.01), metastatic cancer (AOR: 1.30, P < 0.01), age > 70 (AOR: 1.09, P < 0.01)], hospital factors [small vs. large (AOR: 1.07, P < 0.01), non-teaching vs teaching (AOR: 1.10, P < 0.01), private profit vs. non-profit/governmental (AOR: 1.20, P < 0.01)], severe preoperative mortality risk (AOR: 3.48, P < 0.01), and non-elective admission (AOR: 1.38, P < 0.01). HAC were associated with increased: hospitalization length (21 vs 7 days, P < 0.01), hospital charges ($164,803 vs $54,858, P < 0.01), and mortality (8 vs 3%, AOR: 1.14, P < 0.01). Conclusion: HAC incidence was highest among patients with severe comorbid conditions. While small, non-teaching, and for-profit hospitals had increased HAC, the strongest HAC risks were non-modifiable patient factors (preoperative loss function, diabetes, paraplegia, advanced age, etc.). This data questions the validity of using HAC as hospital performance measures, since hospitals caring for these complex patients would be unduly penalized. CMS should consider patient comorbidity as a crucial factor influencing HAC development. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|