Since 2001, several national initiatives have been developed in efforts to improve patient outcomes and safety; a number of these have focused specifically on patients hospitalized for acute myocardial infarction (MI), congestive heart failure, pneumonia, or surgery. Given that the results of these efforts have not been clearly quantified, the authors of a recent study examined data from the Medicare Patient Safety Monitoring System to evaluate adverse event rates from 2005 to 2011 among patients hospitalized for these reasons in 4,372 hospitals across the 50 states, the District of Columbia, and Puerto Rico.
The study included a total of 61,523 patients ages 65 years or older hospitalized for acute MI (11,399), congestive heart failure (15,374), pneumonia (18,269), or conditions necessitating surgery (16,481). The authors focused on three primary outcomes: the rate of adverse events for which patients are known to be at risk (such as warfarin-associated complications), the proportion of patients with one or more adverse events, and the number of adverse events per 1,000 hospitalizations.
Significant decreases in these three outcome measures were seen in patients with MI and congestive heart failure but not in patients with pneumonia or those requiring surgery. In all four groups, those with more adverse events had higher rates of in-hospital death than those without adverse events; surprisingly, those rates didn't decline over the study period, despite decreases in mortality and length of hospital stay in the facilities overall.
The authors suggest that the reduction in adverse events in patients with acute MI and congestive heart failure but not in those with pneumonia or undergoing surgery may be a result of successful initiatives focused specifically on those groups of cardiac patients. Given the large number of patients with MI or congestive heart failure nationally, the authors estimate that the reduction in adverse events resulted in 81,000 events averted between 2005 and 2011. Although programs have focused on decreasing rates of surgery-related adverse events, such incidents remain an issue and should be a target for future initiatives.
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