Care complexity individual factors associated with adverse events and in-hospital mortality

Abstract

Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular

Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia

“…The in-hospital mortality observed in this study was 2.7%. Previous literature reported the in-hospital mortality of 1 to 5% [5,[23][24][25][26], with two multicenter studies reporting rates 2.2% [5,23], our result is consistent with previous literature. Identifying predictor factors for pneumonia in patients is crucial in clinical decision making The death of frail elderly with pneumonia is not frequently only due to pneumonia itself [5,30].…”

Epidemiology of patient safety incidents in a long-term rehabilitative hospital in KwaZulu-Natal, South Africa (April 2011 to March 2016)

“…Longer length of stay, comorbidities, postural hypotension and mental health condition such as depression and delirium increase the risk of PSI in older patients because of their increased requirement for care. Adamuz et al’s 2020 . A systematic review using data from eight studies conducted in the United States, United Kingdom, New Zealand, Canada and Australia showed that most PSI resulted in little or no disability, a significant minority (median 14%) caused permanent disability (7%) or death (7%) (De Vries et al 2008 ).…”

Comparing the dangers of a stay in English and German hospitals for high‐need patients

“…Previous research has suggested that the risk of an adverse event increases with patient complexity 26 and length of stay. 25 Due to their clinical profile and utilization pattern, high-need patients are therefore particularly vulnerable, with an adverse event risking further deterioration of health status and adding complexity to patient care.…”

“…Adverse events almost always occur in combination with an underlying health condition 24 and correlate with length of stay. 25 The overall risk for an adverse event appears highest for complex and more clinically severe types of patients, 26 with a study from Australia estimating that each additional night in hospital increases the risk of an adverse event between 0.5% and 1.6%. 25 It is therefore possible that the burden of adverse events is disproportionately affecting high-need patients (i.e., patients with high utilization of health care services due to a complex disease profile), considering their higher frequency of hospitalization, characterized by complex care needs and longer length of stay.…”