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Article
October 1992

Iatrogenic Complications in High-Risk, Elderly Patients

Author Affiliations

From the Division of General Internal Medicine (Drs Lefevre, Feinglass, Potts, Soglin, Martin, and Yarnold), Center for Health Services and Policy Research (Dr Feinglass), and Buehler Center on Aging (Dr Webster), Northwestern University Medical School, Chicago, Ill.

Arch Intern Med. 1992;152(10):2074-2080. doi:10.1001/archinte.1992.00400220090016
Abstract

Background.—  This study explores the quality improvement potential of reviewing care for long-stay, elderly medicine service patients hospitalized for congestive heart failure, acute myocardial infarction, or pneumonia at a large Midwestern teaching hospital.

Methods.—  Medical records were reviewed for 120 patients aged 65 years or older who were discharged between January 1987 and June 1989, with hospital stays of 15 days or longer. Patients' severity of illness on admission was rated using the Medicare Mortality Predictor System; process quality of care was rated using a structured implicit review form for judging several dimensions of clinical assessment and decision making. Serious complications were coded by etiology and type and judged as possibly or probably preventable. Logistic regression was used to identify risk factors for iatrogenic events; multiple regression was used to assess potential outcome bias in ratings of overall quality of care.

Results.—  Of 120 medical records reviewed, 70 (58.3%) suffered at least one iatrogenic complication. Forty-three patients (35.8%) suffered an iatrogenic complication rated as potentially preventable. Significant predictors of all iatrogenic complications were quality ratings of initial physician assessment, patients' inability to walk unassisted, and low Glasgow Coma Score. For potentially preventable complications, quality ratings for physician documentation of functional status were also significant. Ratings for overall quality of care were not significantly influenced by the mere presence of death or complications.

Conclusions.—  Iatrogenic complications are likely to be an extremely common experience for elderly medicine service patients with long lengths of stay. A significant portion of these complications may be potentially preventable with closer attention to initial assessment and documentation of patients' functional status.(Arch Intern Med. 1992;152:2074-2080)

References
1.
Haley RW, Culver DH, White JW, Morgan WM, Emori TG.  The nationwide nosocomial infection rate: a new need for vital statistics .  Am J Epidemiol. 1985;121:159-167.
2.
Abramson NS, Wald KS, Grenvik ANA, Robinson D, Snyder JV.  Adverse occurrences in intensive care units .  JAMA. 1980;244:1582-1584.Crossref
3.
Gurwitz JH, Avorn J.  The ambiguous relation between aging and adverse drug reactions .  Ann Intern Med. 1991;144:956-966.Crossref
4.
Nolan L, O'Malley K.  Prescribing for the elderly, I: sensitivity of the elderly to adverse drug reactions .  I Am Geriatr Soc. 1988;36:142-149.
5.
Sage WM, Hurst CR, Silverman JF, Bortz WM.  Intensive care for the elderly: outcome of elective and nonelective admissions .  J Am Geriatr Soc. 1987;35:312-318.
6.
Karch FE, Lasagna L.  Adverse drug reactions: a critical review .  JAMA. 1975;234:1236-1241.Crossref
7.
Leape LL, Brennan TA, Laird N, et al.  The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II .  N Engl J Med. 1991;324:377-384.Crossref
8.
Brennan TA, Leape LL, Laird LN, et al.  Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I .  N Engl J Med. 1991;324:370-376.Crossref
9.
Steel K, Gertman PM, Crescenzi C, Anderson J.  Iatrogenic illness on a general medical service at a university hospital .  N Engl J Med. 1981;304:638-642.Crossref
10.
Gillick MR, Serrell NA, Gillick LS.  Adverse consequences of hospitalization in the elderly .  Soc Sci Med. 1982;16:1033-1038.Crossref
11.
Becker PM, McVey LJ, Saltz CC, Feussner JR, Cohen HJ.  Hospital-acquired complications in a randomized controlled clinical trial of a geriatric consultation team .  JAMA. 1987;257:2313-2317.Crossref
12.
Jahnigen D, Hannon C, Laxson L, LaForce FM.  Iatrogenic disease in hospitalized elderly veterans .  J Am Geriatr Soc. 1982;30:387-390.
13.
Williamson JW, Moore DE, Sanazaro PJ.  Moving from 'small qa' to 'large qa': an outcomes framework for improving quality management .  Eval Health Prof. 1991;14:131-137.Crossref
14.
Rolph JE, Kravitz RL, McGuigan K.  Malpractice claims data as a quality improvement tool: is targeting effective?  JAMA. 1991;266:2093-2097.Crossref
15.
Lohr KN, ed..  Medicare: A Strategy for Quality Assurance . Washington, DC: Division of Health Care Services, Institute of Medicine, National Academy Press; 1990.
16.
Daley J, Jencks S, Draper D, Lenhart G, Thomas N, Walker J.  Predicting hospital-associated mortality for Medicare patients: a method for patients with stroke, pneumonia, acute myocardial infarction, and congestive heart failure .  JAMA. 1988;260:3617-3624.Crossref
17.
Rubenstein LV, Kahn KL, Reinisch EJ, et al.  Changes in quality of care for five diseases measured by implicit review, 1981 to 1986 .  JAMA. 1990;264:1974-1979.Crossref
18.
Rubins HA, Moskowitz MA.  Complications of care in a medical intensive care unit .  J Gen Intern Med. 1990;5:104-109.Crossref
19.
Caplan RA, Posner KL, Cheney FW.  Effect of outcome on physician judgments of appropriateness of care .  JAMA. 1991;265:1957-1960.Crossref
20.
DuBois RW, Brook RH.  Preventable deaths: who, how often, and why?  Ann Intern Med. 1988;109:582-589.Crossref
21.
Brennan TA, Localio RJ, Laird NL.  Reliability and validity of judgments concerning adverse events suffered by hospitalized patients .  Med Care. 1989;27:1148-1158.Crossref
22.
Brennan TA, Hebert LE, Laird NM, et al.  Hospital characteristics associated with adverse events and substandard care .  JAMA. 1991;265:3265-3269.Crossref
23.
Wan TTH, Shukla RK.  Contextual and organizational correlates of the quality of hospital nursing care .  Qual Rev Bull. 1987;13:61-64.
24.
Weinberg NS.  The relation of medical problem solving and therapeutic errors to disease categories .  Qual Rev Bull. 1989;15:266-272.
25.
Brady WJ, Hissa DC, McConnell M, Wones RG.  Should physicians perform their own quality assurance audits?  J Gen Intern Med. 1988;3:560-565.Crossref
26.
Brook RH, Kamberg CJ, Mayer-Oakes A, Beers MH, Raube K, Steiner A.  Appropriateness of Acute Medical Care for the Elderly: An Analysis of the Literature . Santa Monica, Calif: RAND Corp; 1989; publication No. R-3717-AARP/HF/RWJ/RC.
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