Article Figures & Tables
Tables
Characteristic No. (%) of patients* Standardized difference Hospital harm
n = 36 004No hospital harm
n = 574 975Age, yr, mean ± SD 64.88 ± 19.83 55.94 ± 21.02 0.44 Sex, female 20 282 (56.3) 350 975 (61.0) 0.10 Neighbourhood income quintile Q1 (lowest) 8571 (23.8) 136 070 (23.7) 0.00 Q2 7972 (22.1) 121 293 (21.1) 0.03 Q3 7150 (19.9) 113 086 (19.7) 0.00 Q4 6231 (17.3) 104 643 (18.2) 0.02 Q5 (highest) 6015 (16.7) 98 954 (17.2) 0.01 Rural residence 4034 (11.2) 72 331 (12.6) 0.04 No. of chronic conditions 0 11 288 (31.4) 129 606 (22.5) 0.20 1 3170 (8.8) 91 936 (16.0) 0.22 2 3441 (9.6) 88 306 (15.4) 0.18 3 3959 (11.0) 79 057 (13.7) 0.08 4 4152 (11.5) 63 977 (11.1) 0.01 ≥ 5 9994 (27.8) 122 093 (21.2) 0.15 Major clinical category, intervention† 18 256 (50.7) 224 466 (39.0) 0.24 Hospital Frailty Risk Score (29) Low risk (< 5) 29 186(81.1) 564 046 (98.1) 0.58 Intermediate (5–15)/high risk (> 15)‡ 6818 (18.9) 10 929 (1.9) 0.58 Teaching hospital 14 844 (41.2) 176 176 (30.6) 0.22 Postadmission conditions, yes – 47 025 (8.2) – PCE category Pregnancy 4524 (12.6) 117 361 (20.4) 0.21 Trauma 6175 (17.2) 37 774 (6.6) 0.33 Mental health 229 (0.6) 38 404 (6.7) 0.33 Cancer 4284 (11.9) 34 153 (5.9) 0.21 Renal 425 (1.2) 4314 (0.7) 0.04 Planned surgical 6080 (16.9) 104 131 (18.1) 0.03 Planned medical 183 (0.5) 5359 (0.9) 0.05 Unplanned surgical 5237 (14.5) 45 212 (7.9) 0.21 Unplanned medical 8867 (24.6) 188 267 (32.7) 0.18 Harm category Health care– or medication-associated conditions 18 027 (50.1) – – Health care–associated infections 13 328 (37.0) – – Patient accidents 967 (2.7) – – Procedure-associated conditions 9819 (27.3) – – No. of hospital admissions within 1 yr before index admission, mean ± SD 0.30 ± 0.82 0.22 ± 0.70 0.11 No. of ED visits within 1 yr before index admission, mean ± SD 1.30 ± 2.36 1.31 ± 2.99 0.01 Note: ED = emergency department, PCE = person-centred episodes of care, SD = standard deviation.
↵* Unless stated otherwise.
↵† International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada diagnosis codes are used to categorize patients into major clinical categories. These broad categories are based on the most responsible diagnosis code. This diagnosis is the one determined to have been responsible for the greatest portion of the patient’s length of stay. Major clinical categories are divided into 2 partitions: intervention and diagnosis.
↵‡ Because of small cell counts in those deemed high risk based on Hospital Frailty Risk Score, intermediate and high-risk groups were combined.
- Table 2:
Impact of hospital harm on incremental length of hospital stay, incremental duration of first person-centred episode of care and incremental costs of first person-centred episode of care*
PCE category Length of hospital stay, d, mean ± SD p value Duration of first PCE, d, mean ± SD p value Cost of first PCE, 2017 Can$, mean ± SD p value Hospital harm No hospital harm Incremental Hospital harm No hospital harm Incremental Hospital harm No hospital harm Incremental Pregnancy 3.5 ± 0.3 3.1 ± 0.3 0.4 ± 0.3 < 0.001 35.0 ± 1.6 34.6 ± 2.0 0.3 ± 2.0 < 0.001 6172 ± 896 5373 ± 909 800 ± 909 < 0.001 Trauma 25.0 ± 10.2 7.7 ± 2.9 17.3 ± 4.9 < 0.001 82.0 ± 16.3 51.8 ± 11.6 30.2 ± 12.5 < 0.001 70 556 ± 28 063 22 732 ± 8496 47 824 ± 13 732 < 0.001 Mental health 34.3 ± 12.8 10.1 ± 4.0 24.2 ± 4.6 < 0.001 85.2 ± 23.7 58.0 ± 43.4 27.2 ± 42.9 < 0.001 43 693 ± 16 913 25 679 ± 17 502 18 014 ± 17 481 < 0.001 Cancer 18.0 ± 5.7 6.5 ± 1.1 11.5 ± 2.3 < 0.001 62.9 ± 8.5 46.2 ± 4.5 16.7 ± 5.2 < 0.001 48 775 ± 15 086 21 424 ± 4686 27 351 ± 6879 < 0.001 Renal 19.6 ± 7.9 8.2 ± 3.0 11.4 ± 3.8 < 0.001 68.2 ± 12.6 52.7 ± 16.8 15.6 ± 16.4 < 0.001 49 732 ± 18 458 23 421 ± 8406 26 311 ± 9913 < 0.001 Planned surgical 10.6 ± 3.0 3.7 ± 0.5 6.9 ± 0.9 < 0.001 51.0 ± 6.5 37.3 ± 3.7 13.6 ± 3.9 < 0.001 35 406 ± 11 033 12 375 ± 2551 23 031 ± 3699 < 0.001 Planned medical 22.2 ± 7.7 6.7 ± 1.4 15.5 ± 2.0 < 0.001 75.8 ± 11.7 49.5 ± 11.6 26.3 ± 11.6 < 0.001 51 719 ± 16 264 18 362 ± 5807 33 357 ± 6495 < 0.001 Unplanned surgical 22.4 ± 8.9 6.6 ± 1.4 15.8 ± 3.3 < 0.001 71.3 ± 13.2 46.2 ± 313.5 25.1 ± 294.1 < 0.001 70 232 ± 28 108 19 164 ± 23 636 51 067 ± 24 216 < 0.001 Unplanned medical 19.4 ± 8.2 6.7 ± 1.8 12.7 ± 2.5 < 0.001 67.1 ± 17.5 47.9 ± 88.4 19.1 ± 86.3 < 0.001 44 353 ± 19 146 16 909 ± 11 945 27 445 ± 12 396 < 0.001 Note: PCE = person-centred episodes of care, SD = standard deviation.
↵* Incremental outcomes and p values are adjusted by all the covariates of interest (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.181621/-/DC1).
- Table 3:
System impact during episodes of care associated with hospital harm during fiscal year 2015/16*
PCE category No. of cases of harm Incremental acute days Incremental duration of first PCE Incremental cost of first PCE, 2017 Can$ Days per patient Total days Days per patient Total days Cost per patient Total cost Pregnancy 4524 0.38 1700 0.32 1468 800 3 617 540 Trauma 6175 17.27 106 645 30.21 186 553 47 824 295 313 077 Mental health 229 24.23 5549 27.23 6235 18 014 4 125 135 Cancer 4284 11.50 49 247 16.72 71 618 27 351 117 169 842 Renal 425 11.39 4842 15.57 6619 26 311 11 182 128 Planned surgical 6080 6.89 41 875 13.64 82 941 23 031 140 027 325 Planned medical 183 15.55 2845 26.29 4811 33 357 6 104 265 Unplanned surgical 5237 15.80 82 750 25.14 131 679 51 067 267 439 974 Unplanned medical 8867 12.66 112 244 19.14 169 722 27 445 243 351 091 Total 36 004 11.32 407 696 18.38 661 646 30 228 1 088 330 376 Note: PCE = person-centred episodes of care.
↵* Incremental outcomes are adjusted by all the covariates of interest.