Tatyana A Shamliyan1, Robert L Kane. 1. From the *Evidence-Based Medicine Center, Clinical Solutions, Elsevier, Philadelphia, Pennsylvania; and †Minnesota Evidence Based Practice Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Abstract
OBJECTIVES: We examined drug harms in Medicare beneficiaries using the 2000-2008 data from the Nationwide Inpatient Sample Healthcare Cost and Utilization Project. RESEARCH DESIGN: This is a cross-sectional study to examine the national estimates of potentially preventable drug-related hospitalizations and in-hospital adverse drug events identified with the International Classification of Diseases codes excluding intentional harms. RESULTS: Hospitalizations related to drug poisoning constituted 0.8% of all Medicare hospitalizations. Annual hospital charges increased from $1.6 billion in 2000 to $4 billion in 2008. In-hospital adverse drug events were noted in 5.3% of all Medicare hospitalizations and increased by 90% from 2000 to 2008. Patients with extreme versus minor loss of function (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.93-2.99) and with extreme versus minor likelihood of dying (OR, 2.30; 95% CI, 2.29-2.33) had increased odds of in-hospital adverse drug events after adjustment for age, sex, and race. The Medicare beneficiaries with more than 5 versus fewer than 5 listed diagnoses had greater odds of in-hospital adverse drug events (OR, 3.79; 95% CI, 3.76-3.82). Each additional diagnosis at discharge was associated with a 13% increase in odds of in-hospital death in the Medicare beneficiaries hospitalized with drug-related diagnoses and with 12% increase in odds of in-hospital death in the Medicare beneficiaries with in-hospital adverse events. CONCLUSIONS: Potentially preventable drug harms are a growing clinical and financial burden. Comparative outpatient drug safety should be analyzed using Medicare claim databases. In-hospital management of drug safety should target patients with multimorbidity and functional decline.
OBJECTIVES: We examined drug harms in Medicare beneficiaries using the 2000-2008 data from the Nationwide Inpatient Sample Healthcare Cost and Utilization Project. RESEARCH DESIGN: This is a cross-sectional study to examine the national estimates of potentially preventable drug-related hospitalizations and in-hospital adverse drug events identified with the International Classification of Diseases codes excluding intentional harms. RESULTS: Hospitalizations related to drug poisoning constituted 0.8% of all Medicare hospitalizations. Annual hospital charges increased from $1.6 billion in 2000 to $4 billion in 2008. In-hospital adverse drug events were noted in 5.3% of all Medicare hospitalizations and increased by 90% from 2000 to 2008. Patients with extreme versus minor loss of function (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.93-2.99) and with extreme versus minor likelihood of dying (OR, 2.30; 95% CI, 2.29-2.33) had increased odds of in-hospital adverse drug events after adjustment for age, sex, and race. The Medicare beneficiaries with more than 5 versus fewer than 5 listed diagnoses had greater odds of in-hospital adverse drug events (OR, 3.79; 95% CI, 3.76-3.82). Each additional diagnosis at discharge was associated with a 13% increase in odds of in-hospital death in the Medicare beneficiaries hospitalized with drug-related diagnoses and with 12% increase in odds of in-hospital death in the Medicare beneficiaries with in-hospital adverse events. CONCLUSIONS: Potentially preventable drug harms are a growing clinical and financial burden. Comparative outpatient drug safety should be analyzed using Medicare claim databases. In-hospital management of drug safety should target patients with multimorbidity and functional decline.