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IIR 07-072 – HSR Study

IIR 07-072
Patient Safety and Costs in VA Hospitals
Kathleen Carey, PhD
VA Bedford HealthCare System, Bedford, MA
Bedford, MA
Funding Period: April 2009 - March 2011
VA has become a model for improvements in prevention and reduction of inadvertent harm to its patients as a result of their medical care. In the current era of rapidly escalating hospital costs, concern over the breadth of medical errors also raises economic issues. Yet to date, there is limited understanding of the economics of recent enhanced patient safety efforts within VA.

1. To establish the empirical relationship between potentially preventable adverse events in VA hospitals and VA hospital costs.
2. To assess the potential for cost savings associated with reduction of adverse events in VA hospitals.

We estimated the excess cost of hospital inpatient care due to adverse patient safety events and post-surgical complications in VA hospitals during fiscal year 2007. The adverse patient safety event measures were Patient Safety Indicators (PSIs), determined with the algorithms of the Agency for Healthcare Research and Quality and the post-surgical complications were those complied by the VA National Surgical Quality Improvement Program. We performed patient level cost regression analyses using generalized linear modeling techniques. We tested sensitivity of results to whether costs were measured by VA's Decision Support System (DSS) that uses local costs of specific inputs, or by the average costing system developed by VA's Health Economics Resource Center (HERC).

Accounting for the heavily skewed distribution of costs among patients with an adverse event, results suggested that the excess cost of nine different PSIs for VA patients are much higher than previously estimated ranging from one-third to three times higher than costs in the absence of a PSI. For postoperative complications, excess costs ranged from 3 percent to 120 percent higher than costs in the absence of post-surgical complications. DSS costing appeared to better characterize high cost patients experiencing adverse events than HERC costing.

Policymakers are aware of the broad extent of medical errors in U.S. hospitals, but conclusions regarding their relative cost have for the most part relied on relatively small samples of patients. This study begins to fill the gap in assessing the excess costs of a range of adverse patient safety events and post-surgical complications. Through reduction of such events, VA hospital managers and clinicians will simultaneously promote the fundamental goals of higher patient care quality while substantially lowering the cost of health care delivery to veterans.

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Journal Articles

  1. Carey K, Stefos T, Shibei Zhao, Borzecki AM, Rosen AK. Excess costs attributable to postoperative complications. Medical care research and review : MCRR. 2011 Aug 1; 68(4):490-503. [view]
  2. Carey K, Stefos T. Measuring the cost of hospital adverse patient safety events. Health economics. 2011 Dec 1; 20(12):1417-30. [view]
Conference Presentations

  1. Carey K. Measuring the Cost of Hospital Adverse Patient Safety Events. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 29; Boston, MA. [view]

DRA: Health Systems
DRE: Prevention, Research Infrastructure
Keywords: none
MeSH Terms: none

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