Publicação
The independent effect of in-hospital adverse events on mortality and readmission in a heart failure population
| Resumo: | One of the metrics most commonly used to evaluate the quality of care in American hospitals is the frequency of in-hospital adverse events. They continue to be a major reason for concern as they pose significant harm to patients as well as tremendous financial consequences to healthcare institutions. However, despite the increased research about the incidence and consequences of inhospital adverse events, there is a paucity of information regarding its independent effect on mortality and readmission in specific and homogenous populations. The main objective of this thesis was to understand and determine the independent effect of adverse events on both mortality and readmission in a heart failure population, which would not only address a considerable gap in the literature, but also provide a quantification of the impact of adverse events on these outcomes, that could prove useful in the institutional and nationwide decision of how many resources to direct to their prevention. In order to study the independent effect of adverse events on both outcomes, a homogenous population (heart failure) was chosen to reduce the issues of patient heterogeneity, and several confounding variables (patients‘ characteristics) were included in the statistical analyses. Among a sample of 1,660 patients discharged from the hospital with a main diagnosis of heart failure, about 22% suffered at least on adverse event during their hospitalization. Results from the multivariate models obtained for each one of the outcomes showed an increased risk of in-hospital mortality (OR 4.47; p = 0.001) among the patients who had an adverse event during their hospitalization, while no association was found between adverse events and post-discharge 30-day mortality (OR 0.97; p = 0.930). Regarding 30-day readmissions, adverse events do not seem to be a predictor of an increased risk of readmission (OR 1.03; p < 0.8644). In conclusion, to the best of our knowledge, this is the first study to consider the independent effect of adverse events on mortality and readmission on one specific population, by controlling for confounding variables. The risk of adverse events seems to be limited to in-hospital mortality only (OR = 4.47), and not to post-discharge 30-day mortality (OR = 0.97) or 30-day readmission (OR = 1.03). |
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| Autores principais: | Gomes, João Pedro Castro Coelho Oliveira |
| Assunto: | Ciências Médicas::Outras Ciências Médicas |
| Ano: | 2014 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade do Minho |
| Idioma: | português |
| Origem: | RepositóriUM - Universidade do Minho |
| Resumo: | One of the metrics most commonly used to evaluate the quality of care in American hospitals is the frequency of in-hospital adverse events. They continue to be a major reason for concern as they pose significant harm to patients as well as tremendous financial consequences to healthcare institutions. However, despite the increased research about the incidence and consequences of inhospital adverse events, there is a paucity of information regarding its independent effect on mortality and readmission in specific and homogenous populations. The main objective of this thesis was to understand and determine the independent effect of adverse events on both mortality and readmission in a heart failure population, which would not only address a considerable gap in the literature, but also provide a quantification of the impact of adverse events on these outcomes, that could prove useful in the institutional and nationwide decision of how many resources to direct to their prevention. In order to study the independent effect of adverse events on both outcomes, a homogenous population (heart failure) was chosen to reduce the issues of patient heterogeneity, and several confounding variables (patients‘ characteristics) were included in the statistical analyses. Among a sample of 1,660 patients discharged from the hospital with a main diagnosis of heart failure, about 22% suffered at least on adverse event during their hospitalization. Results from the multivariate models obtained for each one of the outcomes showed an increased risk of in-hospital mortality (OR 4.47; p = 0.001) among the patients who had an adverse event during their hospitalization, while no association was found between adverse events and post-discharge 30-day mortality (OR 0.97; p = 0.930). Regarding 30-day readmissions, adverse events do not seem to be a predictor of an increased risk of readmission (OR 1.03; p < 0.8644). In conclusion, to the best of our knowledge, this is the first study to consider the independent effect of adverse events on mortality and readmission on one specific population, by controlling for confounding variables. The risk of adverse events seems to be limited to in-hospital mortality only (OR = 4.47), and not to post-discharge 30-day mortality (OR = 0.97) or 30-day readmission (OR = 1.03). |
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