PMID- 2046108
OWN - NLM
STAT- MEDLINE
DCOM- 19910715
LR  - 20161017
IS  - 0098-7484 (Print)
IS  - 0098-7484 (Linking)
VI  - 265
IP  - 24
DP  - 1991 Jun 26
TI  - Hospital characteristics associated with adverse events and substandard care.
PG  - 3265-9
AB  - To explore the epidemiology of adverse events (AEs), which were defined as 
      injuries due to medical treatment, and that subset of AEs caused by negligence, 
      we studied interhospital variation in these outcomes in a sample of 31,000 
      medical records drawn from a random selection of 51 hospitals in New York in 
      1984. We found a substantial variation in both AE rates (0.2% to 7.9%; mean, 
      3.2%) and the percentage of AEs due to negligence (1% to 60%; mean, 24.9%) among 
      hospitals. Univariate analyses of AEs revealed that primary teaching institutions 
      had significantly higher rates (4.1%) and rural hospitals had significantly lower 
      ones (1.0%). The percentage of AEs due to negligence was lower in primary 
      teaching (10.7%) and for-profit (9.5%) hospitals and was significantly higher in 
      hospitals with predominantly (greater than 80%) minority patients who had been 
      discharged (37%). These findings were corroborated by multivariate analysis. Our 
      results suggest that AEs and negligence are not randomly distributed and that 
      certain types of hospitals have significantly higher rates of injuries due to 
      substandard care. These observations may represent an important improvement on 
      existing measures of quality because they take into account the fact that some 
      hospitals' populations may be at risk of suffering a poor outcome.
FAU - Brennan, T A
AU  - Brennan TA
AD  - Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02115.
FAU - Hebert, L E
AU  - Hebert LE
FAU - Laird, N M
AU  - Laird NM
FAU - Lawthers, A
AU  - Lawthers A
FAU - Thorpe, K E
AU  - Thorpe KE
FAU - Leape, L L
AU  - Leape LL
FAU - Localio, A R
AU  - Localio AR
FAU - Lipsitz, S R
AU  - Lipsitz SR
FAU - Newhouse, J P
AU  - Newhouse JP
FAU - Weiler, P C
AU  - Weiler PC
AU  - et al.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - IM
CIN - JAMA. 1991 Dec 4;266(21):2983; author reply 2984. PMID: 1820461
CIN - JAMA. 1991 Dec 4;266(21):2983; author reply 2984. PMID: 1820462
CIN - JAMA. 1991 Dec 4;266(21):2983-4. PMID: 1820463
MH  - Hospital Records/statistics & numerical data
MH  - Hospitals/*standards
MH  - Hospitals, Rural/standards
MH  - Hospitals, University/standards
MH  - Hospitals, Urban/standards
MH  - Humans
MH  - Iatrogenic Disease/*epidemiology
MH  - Minority Groups/statistics & numerical data
MH  - New York/epidemiology
MH  - Quality of Health Care/*statistics & numerical data
MH  - Regression Analysis
MH  - Sampling Studies
EDAT- 1991/06/26 00:00
MHDA- 1991/06/26 00:01
CRDT- 1991/06/26 00:00
PHST- 1991/06/26 00:00 [pubmed]
PHST- 1991/06/26 00:01 [medline]
PHST- 1991/06/26 00:00 [entrez]
PST - ppublish
SO  - JAMA. 1991 Jun 26;265(24):3265-9.