Thinking globally and acting locally: Findings from the national healthcare quality and disparities report (NHQR-DR) on patient safety outcomes in the United States

Background: In 2004, the WHO recognized Patient Safety as a global health-care crisis, urging countries to engage in activities that improve patient safety. An estimated 44,000-98,000 Americans die each year from medical errors. In 2005, the US Patient Safety and Quality Improvement Act was passed to improve quality, safety and outcomes of patient care. The Partnership for Patients initiative aims to reduce hospital-acquired conditions by 40% by December 2013 by funding public and private hospitals to introduce evidence-based strategies within their institutions. Findings from the National Healthcare Quality and Disparities Report (NHQR-DR) are presented to identify aspects of patient safety that need urgent attention.

Methods: Some 34 NHQR-DR patient safety measures are organized into 4 categories: Healthcare-Associated Infections (HAIs), Surgical Complications, Medication Complications, and Other Hospital Complications. The measures are stratified by race/ethnicity, age, gender, income, insurance, and hospital location. Significant differences are those with a p-value <0.05 (two-tailed test), and a minimum relative difference of >10% between the comparison and reference groups.

Findings: Healthcare-associated infections: In 2009, hospitals in medium metropolitan, small metropolitan, micropolitan and non-metropolitan had lower rates of postoperative sepsis than those in large fringe areas. In 2009, patients ages 45-64 (4.21 per 1000 hospital discharges) had higher catheter-related bloodstream infections than those ages 18-44 (2.14 per 1000 hospital discharges).

Surgical Complications: From 2000-2009, Non-Hispanic Whites, Non-Hispanic Blacks and Hispanics with private insurance had significantly lower rates of re-closure of postoperative abdominal wound dehiscence than did individuals with Medicaid. Medication Complications: In 2010, the percentage of hospital patients age 65 and over who had an adverse drug event associated with a hypoglycemic agent (11.2%) was significantly higher than it was for patients under age 65 (8.3%). Non-Hispanic Blacks had higher rates of hypoglycemic agent adverse events (12.7%) than did non-Hispanic Whites (9.5%).

Other Hospital Complications: From 2005-2009, the mortality rate for hospital admissions with low expected mortality was significantly higher for lower income adults than for higher income adults and the rate for males were more than twice the rate for females.

Conclusions: Disparities in HAIs and surgical, medication, and other hospital complications exist for individuals of lower socioeconomic status, racial minorities, older adults, males and hospitals located in large fringe areas. Programs like the Partnership for Patients should continue to provide focused policies and research that identify ways to improve the areas of concern highlighted in this evaluation.