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Death of a patient in the hospital is a high-priority medical outcome. Some hospital deaths may be due to inadequate care and are potentially preventable. An adverse event during a hospital stay is defined as a problem of any nature and seriousness experienced by a patient during his or her stay in the hospital that is potentially attributable to clinical or administrative management rather than the underlying disease. A study in a hospital in Granada, Spain, assessed whether there was a relationship between adverse events and deaths during hospital stay \([18] .\) In this study, 524 cases (i.e., people who died in the hospital) were identified between January \(1,1990,\) and January \(1,1991 .\) For each case, a control patient was matched on admission diagnosis and admission date. A retrospective chart review determined occurrence of adverse events among all cases and controls. There were 299 adverse events occurring among the cases and 225 among the controls. Among the 299 cases in which an adverse event occurred, 126 of their corresponding matched controls also had an adverse event. What method of analysis can be used to compare the proportion of adverse events between cases and controls?

Step by step solution

01

Identify the Type of Study

This is a case-control study where cases are patients who died in the hospital, and controls are matched patients who did not die, but were admitted on the same diagnosis and date.

02

Understand the Data

From the data: there are 524 cases with 299 adverse events, and 524 controls with 225 adverse events. Additionally, among the 299 cases with adverse events, 126 had controls with adverse events.

03

Selection of Statistical Test

The data involves paired measurements with categorical outcomes (adverse event vs. no adverse event). The McNemar's test is appropriate for analyzing paired dichotomous data to assess the difference in proportions between matched pairs.

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Key Concepts

These are the key concepts you need to understand to accurately answer the question.

Adverse Events

Adverse events in a hospital setting are incidents that negatively impact a patient's health during their stay. These events can range from mild to serious in nature and are distinct because they are not directly caused by the patient's underlying health conditions. Instead, they may arise from the medical care provided or other administrative processes in the hospital.

Here are some examples of adverse events:

• Medication errors, such as incorrect dosage or wrong medication prescribed.
• Infections acquired during the hospital stay, like a surgical site infection.
• Complications following surgery, for example, excessive bleeding.
• Misdiagnosis or delayed diagnosis that affects treatment outcomes.

Adverse events are crucial for hospitals to track and understand because they can significantly affect patient outcomes and hospital mortality rates. Recognizing and addressing these events is essential for improving patient care and safety.

Hospital Mortality

Hospital mortality refers to the deaths that occur within a hospital setting during a patient's inpatient stay. This is an important indicator of hospital quality and patient safety, as high mortality rates can suggest potential issues with care delivery.

Factors influencing hospital mortality include:

• Severity and nature of patients' initial illnesses or conditions.
• Efficiency and accuracy of the medical treatment given.
• The occurrence of adverse events during the hospital stay.
• Overall hospital policies and clinical practices.

Hospital mortality is a critical measure used in health studies and healthcare policies to drive improvements in medical care. Understanding the root causes of mortality can help hospitals implement better practices and reduce preventable deaths.

McNemar's Test

McNemar's test is a statistical method used to analyze matched-pair data. It is particularly useful for dichotomous (yes/no) outcomes, such as assessing whether an intervention has an effect when each subject has received both the treatment and control condition in a study.

In the context of the provided exercise, McNemar's test is used to compare the proportion of adverse events between cases (patients who died in the hospital) and their matched controls (patients who had similar admission diagnoses and dates but did not die). It specifically evaluates matched pairs for changes in categorical outcomes.

Here's how it works in this scenario:

• The test looks at cases where both pairs experienced an adverse event and where only one did.
• The structure of the data involves 299 cases with adverse events and among their 524 matched controls, 126 also had adverse events.
• McNemar's test will determine if there is a statistically significant difference in adverse events between these matched pairs.

Utilizing McNemar's test helps to identify whether the presence of adverse events is significantly associated with hospital mortality among the studied pairs, thereby providing insights into potential areas for improvement in patient safety.