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Adverse Events During Medical and Surgical Hospitalizations for Persons With Schizophrenia
Gail L. Daumit, MD, MHS;
Peter J. Pronovost, MD, PhD;
Christopher B. Anthony;
Eliseo Guallar, MD, DrPH;
Donald M. Steinwachs, PhD;
Daniel E. Ford, MD, MPH
Arch Gen Psychiatry. 2006;63:267-272.
Context Persons with schizophrenia have a high risk of premature mortality. It is not clear if greater risk for adverse events during hospitalization is a contributing factor.
Objectives To estimate the prevalence of adverse events in medical and surgical hospitalizations for persons with schizophrenia compared with those for persons without schizophrenia and to examine the relation between adverse events and intensive care unit admission, in-hospital death, length of stay, and total charges for hospitalizations for persons with schizophrenia.
Design Cross-sectional study.
Setting We studied discharges from all Maryland acute care hospitals' medical and surgical services in 2001 and 2002.
Patients There were 1746 medical and surgical hospitalizations for adults with a secondary diagnosis of schizophrenia and 732 158 for adults without schizophrenia.
Main Outcome Measures For primary outcomes, we applied the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs), which were developed to detect adverse events in administrative data. We compared PSIs for hospitalizations for patients with a secondary diagnosis of schizophrenia with those for patients without and determined the association between schizophrenia and each PSI adjusting for patient and hospital characteristics. For hospitalizations for patients with schizophrenia, for secondary outcomes we examined the association between each PSI and intensive care unit admission, in-hospital death, length of stay, and total charges.
Results Hospitalizations for patients with schizophrenia had the following higher adjusted relative odds of having PSIs compared with those for patients without schizophrenia: infections due to medical care (odds ratio [OR], 2.49 [95% confidence interval (CI), 1.28 to 4.88]); postoperative respiratory failure (OR, 2.08 [95% CI, 1.41 to 3.06]); postoperative deep venous thrombosis (OR, 1.96 [95% CI, 1.18 to 3.26]); and postoperative sepsis (OR, 2.29 [95% CI, 1.49 to 3.51]). For hospitalizations for patients with schizophrenia, having respiratory failure or sepsis resulted in at least twice the adjusted odds for intensive care unit admission and death. The median adjusted increase in length of stay was at least 10 days, and median hospital charges were elevated by at least $20 000 for infections due to medical care, respiratory failure, deep venous thrombosis, and sepsis.
Conclusions Medical and surgical hospitalizations for persons with schizophrenia had at least twice the odds of several types of adverse events than those for persons without schizophrenia. These adverse events were associated with poor clinical and economic outcomes during the hospital admission. Efforts to reduce these adverse events should become a research priority.
Author Affiliations: Division of General Internal Medicine (Drs Daumit, Guallar, and Ford and Mr Anthony), Departments of Medicine (Drs Daumit, Guallar, and Ford and Mr Anthony), Surgery (Dr Pronovost), Anesthesia and Critical Care Medicine (Dr Pronovost), and Psychiatry and Behavioral Sciences (Drs Steinwachs and Ford), School of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research (Drs Daumit, Guallar, and Ford and Mr Anthony) and Department of Health Policy and Management (Drs Daumit, Pronovost, Steinwachs, and Ford), School of Medicine and Bloomberg School of Public Health, Department of Epidemiology, Bloomberg School of Public Health (Drs Daumit, Guallar and Ford), Johns Hopkins University, Baltimore, Md.
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