Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #120403

Charles Schade, MD, MPH, Karen Hannah, MBA, and David Lomely. West Virginia Medical Institute, 3001 Chesterfield Place, Charleston, WV 25304, (800) 642-8686x2243, cschade@wvmi.org

Background: Adverse events in health care settings are frequent, but there are no generally-recognized measures expressible as rates that can be used to compare health care facilities or track changes over time. Such measures might be useful for quality improvement, and might contribute to knowledge on a broader scale if they can be compared among multiple investigators.

Objectives: 1. Identify a set of denominator measures that can be used to construct rates of adverse events in health care facilities 2. Construct a set of event rate measures for comparing adverse event occurrences across facilities

Methods: We conducted a structured review of the literature using PubMed, beginning with the MESH term “medical errors/statistics and numerical data,” and adding qualifiers to identify articles containing explicit rate calculations. One author reviewed citations and abstracts to select articles potentially having definitions and descriptions of adverse event rate calculations. From the articles retrieved, we constructed an evidence table containing the type of adverse event (e.g., dosing error), the reported denominator definition, and the observed range of rates, along with descriptive information about the care environment where the adverse events were observed.

Results: We retrieved 456 citations (with some duplications), and identified 60 potentially relevant articles, for which we obtained reprints. Forty-seven articles published between 1995 and 2004 had useable denominator definitions for calculating rates of adverse events. “Adverse events” (not otherwise classified, n=9), and “medication errors” (not otherwise classified, n=9) were the most frequent event types for which rates had been reported. The specificity of adverse event descriptions ranged from “tenfold dose prescribing errors” (the most specific) to “adverse events” (the most general). Using numerator data from voluntary adverse event reports in 6 hospitals, we identified a candidate set of rate measures (Table), for which the structured review suggested appropriate denominators. At the meeting, we will present adverse event rate comparisons among the hospitals and over time.

Conclusions: Structured review was an effective means of solving a practical problem: identifying denominators for comparisons of a broad range of measures so that results of our medical error project can be readily compared with other investigators' findings.

Learning Objectives: Objectives

• Identify a set of denominator measures that can be used to construct rates of adverse events in health care facilities
• Construct a set of event rate measures for comparing adverse event occurrences across facilities

Keywords: Quality of Care, Rural Health Care Delivery System

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation