Table 5.
Hospital's Risk‐Standardized Occurrence Rate of Adverse Events for Which Patients Were at Risk by Tertiles, July 1, 2009 to June 30, 2013 (Aged ≥65 Years or Older, Medicare Fee‐for‐Service Patients Discharged With Acute Myocardial Infarction)
| Measurements of Adverse Events | Total Patients (N=7019) | Hospital's Risk‐Standardized Occurrence Rate of Adverse Events for Which Patients Were at Risk by Tertiles (%) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| First Tertile (1.35–2.82) | Second Tertile (2.83–4.44) | Third Tertile (4.45–19.28) | ||||||||||
| No. of Patients at Risk | Adverse Event Rate | No. of Patients at Risk | Adverse Event Rate | No. of Patients at Risk | Adverse Event Rate | No. of Patients at Risk | Adverse Event Rate | |||||
| n | % | % (95% CI) | n | % | % (95% CI) | n | % | % (95% CI) | n | % | % (95% CI) | |
| Adverse drug events | ||||||||||||
| Adverse events associated with digoxin | 353 | 5.0 | 1.7 (0.6–3.7) | 131 | 5.2 | 0.0 (0.0–2.7) | 106 | 4.7 | 1.9 (0.2–6.7) | 116 | 5.2 | 3.5 (1–8.7) |
| Adverse events associated with hypoglycemic agents | 2853 | 40.6 | 10.5 (9.4–11.7) | 916 | 36.5 | 2.3 (1.4–3.5) | 900 | 39.5 | 10.0 (8.1–12.2) | 1037 | 46.4 | 18.2 (15.9–20.7) |
| Adverse events associated with IV heparin | 2253 | 32.1 | 11.4 (10.1–12.8) | 641 | 25.6 | 2.0 (1.1–3.4) | 711 | 31.2 | 7.3 (5.5–9.5) | 901 | 40.3 | 21.3 (18.7–24.1) |
| Adverse events associated with low‐molecular‐weight heparin and factor Xa inhibitor | 3156 | 45.0 | 5.2 (4.4–6.0) | 1216 | 48.5 | 0.6 (0.2–1.2) | 1032 | 45.3 | 4.3 (3.1–5.7) | 908 | 40.7 | 12.3 (10.3–14.7) |
| Adverse events associated with warfarin | 669 | 9.5 | 6.3 (4.6–8.4) | 203 | 8.1 | 1.0 (0.1–3.5) | 232 | 10.2 | 5.2 (2.7–8.9) | 234 | 10.5 | 12.0 (8.1–16.8) |
| General events | ||||||||||||
| Hospital‐acquired pressure ulcers | 7019 | 100.0 | 5.4 (4.9–6) | 2507 | 100.0 | 1.6 (1.2–2.2) | 2279 | 100.0 | 5.0 (4.2–6) | 2233 | 100.0 | 10.0 (8.8–11.4) |
| Inpatient falls | 7019 | 100.0 | 0.8 (0.6–1.0) | 2507 | 100.0 | 0.2 (0.1–0.5) | 2279 | 100.0 | 0.8 (0.5–1.3) | 2233 | 100.0 | 1.4 (1–2) |
| Hospital‐acquired infections | ||||||||||||
| Hospital‐acquired antibiotic‐associated Clostridium difficile | 3150 | 44.9 | 0.7 (0.4–1.0) | 1051 | 41.9 | 0.0 (0.0–0.4) | 1009 | 44.3 | 0.7 (0.3–1.4) | 1090 | 48.8 | 1.3 (0.7–2.2) |
| Central line‐associated bloodstream infection | 863 | 12.3 | 1.0 (0.5–2.0) | 151 | 6.0 | 0.0 (0.0–2.4) | 268 | 11.8 | 0.7 (0.1–2.7) | 444 | 19.9 | 1.6 (0.6–3.2) |
| Catheter‐associated urinary tract infection | 2471 | 35.2 | 5.9 (5–6.9) | 776 | 31.0 | 2.3 (1.4–3.6) | 803 | 35.2 | 4.5 (3.2–6.2) | 892 | 39.9 | 10.2 (8.3–12.4) |
| Hospital‐acquired methicillin‐resistant Staphylococcus aureus | 6845 | 97.5 | 0.1 (0–0.2) | 2447 | 97.6 | 0.0 (0.0–0.2) | 2213 | 97.1 | 0.0 (0.0–0.2) | 2185 | 97.9 | 0.3 (0.1–0.6) |
| Hospital‐acquired vancomycin‐resistant Enterococcus | 7002 | 99.8 | <0.01 (0.0–0.1) | 2504 | 99.9 | 0.0 (0.0–0.2) | 2270 | 99.6 | 0.0 (0.0–0.2) | 2228 | 99.8 | 0.0 (0.0–0.2) |
| Postoperative Pneumonia | 431 | 6.1 | 7.4 (5.1–10.3) | 44 | 1.8 | 0.0 (0.0–8) | 119 | 5.2 | 3.4 (0.9–8.4) | 268 | 12.0 | 10.4 (7.1–14.8) |
| Ventilator‐associated pneumonia | 229 | 3.3 | 11.4 (7.6–16.2) | 32 | 1.3 | 0.0 (0.0–10.9) | 64 | 2.8 | 3.1 (0.4–10.8) | 133 | 6.0 | 18.0 (11.9–25.7) |
| Postprocedural events | ||||||||||||
| Adverse events associated with femoral artery puncture for catheter angiographic procedures | 2808 | 40.0 | 2.6 (2–3.2) | 657 | 26.2 | 0.5 (0.1–1.3) | 909 | 39.9 | 2.2 (1.4–3.4) | 1242 | 55.6 | 3.9 (2.9–5.2) |
| Adverse events associated with hip joint replacement | 3 | <0.01 | 66.7 (9.4–99.2) | 0 | 0.0 | N/A | 0 | 0.0 | N/A | 3 | 0.1 | 66.7 (9.4–99.2) |
| Adverse events associated with knee joint replacement | 0 | 0.0 | N/A | 0 | 0.0 | N/A | 0 | 0.0 | N/A | 0 | 0.0 | N/A |
| Contrast nephropathy associated with catheter angiography | 2828 | 40.3 | 13.8 (12.5–15.1) | 659 | 26.3 | 2.4 (1.4–3.9) | 919 | 40.3 | 10.2 (8.3–12.4) | 1250 | 56.0 | 22.3 (20–24.7) |
| Mechanical complications associated with central lines | 1087 | 15.5 | 3.3 (2.3–4.6) | 201 | 8.0 | 0.0 (0.0–1.8) | 351 | 15.4 | 2.0 (0.8–4.1) | 535 | 24.0 | 5.4 (3.7–7.7) |
| Postoperative cardiac events (cardiac and noncardiac surgeries) | 465 | 6.6 | 3.4 (2–5.5) | 50 | 2.0 | 0.0 (0.0–7.1) | 127 | 5.6 | 2.4 (0.5–6.8) | 288 | 12.9 | 4.5 (2.4–7.6) |
| Postoperative venous thromboembolic event | 465 | 6.6 | 0.6 (0.1–1.9) | 50 | 2.0 | 0.0 (0.0–7.1) | 127 | 5.6 | 0.8 (0–4.3) | 288 | 12.9 | 0.7 (0.1–2.5) |
| All events | ||||||||||||
| Occurrence event ratea | 51 969 | 7.4b | 3.8 (3.6–3.9) | 16 745 | 6.7b | 0.8 (0.6–0.9) | 16 718 | 7.3b | 3.0 (2.8–3.3) | 18 506 | 8.3b | 7.2 (6.8–7.5) |
| One or more event per hospitalizationc | 7019 | 100.0 | 20.1 (19.2–21.0) | 2507 | 35.7 | 4.9 (4.1–5.8) | 2279 | 32.5 | 19.8 (18.2–21.4) | 2233 | 31.8 | 37.4 (35.4–39.4) |
N/A indicates not applicable.
a
The numerator is the number of adverse events that occurred and the denominator is the number of adverse events for which patients were at risk.
b
Number of adverse events for which patients were at risk per hospitalization.
c
The numerator is the number of patients who experienced one or more adverse events and the denominator is the number of hospitalizations.