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National Healthcare Disparities Report, 2004

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Patient Safety

Medical care can lead to injuries to patients from the care that is intended to help them. Adverse drug reactions, both avoidable and unavoidable, occur in 6.7% of hospitalized patients46 and are rising47. In two studies, preventable adverse drug events were found to occur in about 2% of hospital admissions48,49 and 20% of these events were life-threatening. Among Medicare beneficiaries in ambulatory settings, the overall rate of adverse drug events was 50 per 1,000 person-years; over 40% of serious, life-threatening, or fatal events were deemed preventable50. An estimated 44,000 to 98,000 Americans die each year as a result of medical errors, making it the eighth leading cause of death51. Costs attributable to medical errors are estimated at $17 billion to $29 billion annually51. Visits to U.S. emergency departments for adverse effects of medical treatments increased 67% between 1992 and 199952.

Figure 2.9. Iatrogenic pneumothorax per 1,000 discharges (top) and deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue) (bottom), by race/ethnicity, 2001

Iatrogenic pneumothorax

Figure 2.9. Iatrogenic pneumothorax per 1,000 discharges, by race/ethnicity, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Failure to rescue

Figure 2.9. Iatrogenic deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue), by race/ethnicity, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: HCUP State Inpatient Databases disparities analysis file, 2001.

Reference population: All hospitalized patients (top) and hospitalized patients with complications potentially resulting from care (bottom).

Note: White, Black, and API are non-Hispanic groups. Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. For findings related to all patient safety measures, go to Table 2.10a. Available data do not support analyses stratified by SES.

  • Human error during procedures can sometimes lead to injuries or adverse events. These include accidental laceration, leaving a foreign body, or iatrogenic pneumothorax (puncture of the lung) during a procedure. In 2001, rates of iatrogenic pneumothorax were lower among Hispanics compared with non-Hispanic whites (Figure 2.9, top). Black-white differences were not significant.
  • Deaths that could be avoided include those among patients hospitalized for conditions that rarely result in death and those associated with complications of care. In 2001, deaths from complications potentially resulting from care (failure to rescue) were higher among APIs compared with non-Hispanic whites (Figure 2.9, bottom). Other differences by race/ethnicity were not significant.

Figure 2.10. Postoperative pulmonary embolus or deep vein thrombosis per 1,000 surgical discharges (top) and postoperative septicemia per 1,000 elective surgery discharges of longer than 3 days (bottom), by race/ethnicity, 2001

Postoperative pulmonary embolus

Figure 2.10. Postoperative pulmonary embolus or deep vein thrombosis per 1,000 surgical discharges, by race/ethnicity, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Postoperative septicemia

Figure 2.10. Postoperative septicemia per 1,000 elective surgery discharges of longer than 3 days, by race/ethnicity, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: HCUP State Inpatient Databases disparities analysis file, 2001.

Reference population: Patients hospitalized for surgery (top) and for elective surgery with stay longer than 3 days (bottom).

Note: White, Black, and API are non-Hispanic groups. Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. For findings related to all patient safety measures, go to Table 2.10a. Available data do not support analyses stratified by SES.

Figure 2.11. Various nosocomial infections, by race, 2002

Figure 2.11. Various nosocomial infections, by race, 2002. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: Medicare Patient Safety Monitoring System, 2002.

Reference population: Hospitalized Medicare beneficiaries.

Note: For findings related to all patient safety measures, go to Table 2.10a. Available data do not support analyses stratified by SES.

  • Inpatient care can be compromised by complications that arise during surgery or in the postoperative period. Following surgery, blood clots can form in the legs (deep vein thrombosis) and travel to the lungs (pulmonary embolus). In 2001, rates of postoperative pulmonary embolus or deep vein thrombosis were higher among blacks and lower among APIs compared with non-Hispanic whites (Figure 2.10, top).
  • Nosocomial infections are infections acquired in the hospital. In 2001, rates of postoperative septicemia (life-threatening invasion of the bloodstream by microorganisms) were higher among blacks and Hispanics compared with non-Hispanic whites (Figure 2.10, bottom).
  • Black Medicare beneficiaries also tended to have higher rates of a variety of nosocomial infections associated with operative procedures and central venous catheters (CVCs)—i.e., catheters inserted into large veins near the heart which are commonly used to give medications, fluids, and nutrients to severely ill patients. However, differences compared with whites did not attain statistical significance due to small sample sizes (Figure 2.11).

 

 

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