bjective.
To better understand the remaining three-fold disparity between adverse event (AE) rates in the Quality in
Australia Health Care Study (QAHCS) and the Utah-Colorado Study (UTCOS) after methodological differences had been
accounted for.
Setting.
Iatrogenic injury in hospitalized patients in Australia and America.
Design.
Using a previously developed classification, all AEs were assigned to 98 exclusive descriptive categories and the
relative rates compared between studies; they were also compared with respect to severity and death.
Main outcome measures.
The distribution of AEs amongst the descriptive and outcome categories.
Results.
For 38 categories, representing 67% of UTCOS and 28% of QAHCS AEs, there were no statistically significant
differences. For 33, representing 31% and 69% respectively, there was seven times more AEs in QAHCS than in UTCOS.
Rates for major disability and death were very similar (1.7% and 0.3% of admissions for both studies) but the minor
disability rate was six times greater in QAHCS (8.4% versus 1.3%).
Conclusions.
A similar 2% core of serious AEs was found in both studies, but for the remaining categories six to seven
times more AEs were reported in QAHCS than in UTCOS. We hypothesize that this disparity is due to different thresholds
for admission and discharge and to a greater degree of under-reporting of certain types of problems as AEs by UTCOS
than QAHCS reviewers. The biases identified were consistent with, and appropriate for, the quite different aims of each
study. No definitive difference in quality of care was identified by these analyses or a literature review.
Keywords:
adverse events, complications, iatrogenic injury, medical record review, quality of care
bjective.To better understand the remaining three-fold disparity between adverse event (AE) rates in the Quality inAustralia Health Care Study (QAHCS) and the Utah-Colorado Study (UTCOS) after methodological differences had beenaccounted for.Setting.Iatrogenic injury in hospitalized patients in Australia and America.Design.Using a previously developed classification, all AEs were assigned to 98 exclusive descriptive categories and therelative rates compared between studies; they were also compared with respect to severity and death.Main outcome measures.The distribution of AEs amongst the descriptive and outcome categories.Results.For 38 categories, representing 67% of UTCOS and 28% of QAHCS AEs, there were no statistically significantdifferences. For 33, representing 31% and 69% respectively, there was seven times more AEs in QAHCS than in UTCOS.Rates for major disability and death were very similar (1.7% and 0.3% of admissions for both studies) but the minordisability rate was six times greater in QAHCS (8.4% versus 1.3%).Conclusions.A similar 2% core of serious AEs was found in both studies, but for the remaining categories six to seventimes more AEs were reported in QAHCS than in UTCOS. We hypothesize that this disparity is due to different thresholdsfor admission and discharge and to a greater degree of under-reporting of certain types of problems as AEs by UTCOSthan QAHCS reviewers. The biases identified were consistent with, and appropriate for, the quite different aims of eachstudy. No definitive difference in quality of care was identified by these analyses or a literature review.Keywords:adverse events, complications, iatrogenic injury, medical record review, quality of care
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