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研究生:謝宛如
研究生(外文):Wan-Ju Hsieh
論文名稱:探討有無失智症在不同醫院屬性下發生潛在病安事件的差異
論文名稱(外文):Difference in Patient Safety Events between Inpatients with and without Dementia: The Role of Hospitals
指導教授:黃心苑黃心苑引用關係
指導教授(外文):Nicole Huang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:英文
論文頁數:57
中文關鍵詞:病人安全指標病人安全失智症醫院屬性
外文關鍵詞:AHRQpatient safetydementiahospital characteristics
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研究背景
隨著醫療科技的進步,雖大幅增加醫療服務提供的效益,但在傳遞醫療照護的過程中,仍存在著一些無法避免的風險。自美國於1999年頒布一項病人安全研究報告「To Err Is Human:Building a Safer System」之後,世界各國開始重視病人安全的議題。然而,許多人認為伴隨有多重慢性病問題的老年人,相較於一般住院病患,更無法倖免於病安事件。特別是有認知障礙(如:失智症)的老年患者可能因其大腦退化,導致無法完整表達自身疾病需求,及降低病患遵從性,此外,失智症患者與醫護人員的溝通也會因其認知功能的問題而受到阻礙。過去研究發現失智症患者相較於一般病人有較高的死亡率、再入院率及較長的住院天數,卻少有研究去探究在住院過程中,合併有失智症之老年人的潛在病安情況是否存在不均等的狀況;另一方面,有鑑於不同醫院屬性的組織架構、財源籌措及傳遞醫療服務的方式皆不相同,可能直接影響整體醫療品質及其不均等的情況。因此,本研究欲探討有無失智症之病患在住院過程中,發生潛在病安事件的差異,並進一步分析在不同醫院屬性下,有無失智症兩組病人發生病安事件的狀況是否會有所不同。本研究結果能提供衛生主管機關及臨床工作者,思考針對伴隨認知疾病之慢性患者,其醫療照護方式是否有改變之必要性。

研究目的
探討有無失智症在住院過程中,發生潛在病安事件的差異,並進一步分析上述之差異在不同醫院屬性下是否會有所不同。

研究方法
本研究使用全民健保資料庫2010至2013年之母體檔,根據健保署公告之編碼規則進行DRG編碼。研究對象為全台灣60歲以上住院病患,並排除產科個案及檔案串聯過程中資料不全者。病人安全事件之風險族群定義係採用美國照護研究暨品質中心(Agency for Healthcare Research and Quality, AHRQ)所訂定之住院病人安全指標的5.0版,再依據全民健保資料庫的限制而有所增修。此外,將30天定義為一個療程來處理再入院的問題,意即所有發生於首次住院日之後30天的住院皆視為再入院。為提升有無失智症兩組的可比性,採用傾向分數配對方法(Propensity score matching, PSM),配對後,有無失智症兩組各有62,414個療程。本研究考慮到資料的群集性,遂採用多階層模型(Multilevel model)進行分析,探討有無失智症發生潛在住院病安事件的差異。

研究結果
台灣在2010至2013年,60歲以上住院病患之潛在病安事件發生率為4.76‰,其中醫療照護與手術相關為0.72‰,手術相關則為9.23‰。失智症患者最常發生之病安事件為壓瘡(30.39‰)、術後髖部骨折(4.22‰)及術後肺栓塞或靜脈血栓(2.51‰)。整體而言,失智症患者的潛在病安事件發生風險低於或與一般病患無差異,但是相較於無失智症患者,失智症患者發生壓瘡事件的風險高達2.22倍。此外,本研究發現醫院層級與失智症存在著顯著的交互作用,也就是說,雖然相較於醫學中心及區域醫院,在地區醫院接受治療的住院病患發生壓瘡事件的風險較高;但是有無失智症兩組病患發生壓瘡事件的差異在醫學中心卻是更為顯著的。而失智症患者若於地區醫院接受照護,可能更容易遭受病安事件的傷害。

結論與建議
本研究顯示,潛在病安事件是相對較常發生於住院病患的,雖然失智症患者發生病安的風險低於或與一般60歲以上之住院病患無顯著不同,但是在壓瘡事件上卻有顯著較高的風險。另外,過去研究顯示不同醫院屬性之醫療服務傳遞方式將會影響醫療品質,更會直接影響到認知與生理疾病整合的醫療照護,而本研究發現有無失智症兩組在壓瘡事件上的不均等情形會因不同醫院而有所差異。AHRQ PSIs僅為篩選工具,並非代表真正的病安事件,所標示出的病安事件(flagged events)具警示作用,提醒醫護人員在照護伴隨有失智症的老年住院病患的過程中,更加必須細心謹慎,且建議衛生主管機關應針對整合心理(認知)及生理的照護機構,加強介入監督機制,以減少失智症患者與一般病患的醫療品質差距。
Background
Patient safety has been one major focus in health care system. Many speculate that patients with multiple chronic conditions, particularly those who are cognitively impaired, may be more susceptible to potential patient safety events. Sequels of dementia may hinder people from appropriately expressing their needs, adhering to medical or care instruction during hospitalization, and communicating with care providers. Previous studies showed that patients with dementia faced a higher risk of mortality, length of stay, and institutionalization, but the understanding of preventable adverse events among inpatients with dementia is very limited. Furthermore, it may be also important to explore, if the differences in patient safety do exist between patients with and without dementia, whether such differences may vary by hospital characteristics.

Objectives
We compared patient safety risk between patients with and without dementia, and explore whether the differences in patient safety risk varied by hospital ownership and accreditation level.

Method
This was a population-based pooled cross-section study and data was compiled over four years (2010-2013). The 2010-2013 National Health Insurance inpatient claims data were analyzed. From 2010 to 2013, we identified 4,233,235 inpatients admissions at risk for patient safety events that defined by Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSIs, version 5.0). A total of 77,215 inpatients with dementia and 4,156,020 inpatient without dementia aged 60 years or older were enrolled. In order to increase comparability, we used propensity score matching that matched the two groups of patients at 1:1 ratio by patient demographic characteristics. A 30-day period was used to define an inpatient episode. Any hospitalization occurs within the 30 days following the index admission was considered as a readmission. There were 124,828 episodes in the final sample. We applied multilevel model to control for physician clusters, to determine independent impacts of dementia on total, medical/surgical-related, surgical-related, and pressure ulcer adverse events.

Results
During the study period (2010-2013), the prevalence of any PSI event was 4.76‰. More specifically, the prevalence of medical/surgical and surgical-related PSI events were 0.72‰ and 9.23‰, respectively. The most commonly observed PSI among dementia patients during hospitalization were pressure ulcer (30.39‰), postoperative hip fracture (4.22‰), and postoperative pulmonary embolism or deep vein thrombosis (2.51‰). Although patients with dementia had a lower risk of incurring any PSI event than those without dementia (OR=0.83, 95% CI 0.67-1.02), they were at a significantly higher risk to incur pressure ulcer events than those without dementia (OR=2.22, 95% CI 2.01-2.46). A significant interaction was found between dementia status and hospital accreditation level. Patient safety risks were consistently high for both patients with and without dementia in district hospitals. Although patient safety risks were lower in medical centers and regional hospitals, the differences in patient safety risk between patients with and without dementia in medical centers and regional hospitals were significant. While hospitalized, dementia patients who cared in district hospitals were more likely to suffer from patient safety events.

Conclusions
This study indicated that patient safety events were relatively prevalent in hospitalized patients. Patients with dementia were less likely than general patients aged 60 and older to suffer from patient safety events except for pressure ulcer (PSI 03). The differences of pressure ulcer events between patients with and without dementia may vary across hospitals. The results may help to identify possible areas for inpatient care improvement. Additional work is necessary to explore the mechanisms underlying these findings in order to devise more specific and effective preventive strategies to reduce patient safety events such as pressure ulcer. Also, pondering what is the ideal medical care that integrated the physical and cognitive illnesses for the elderly is a top priority.
CONTENTS
誌 謝 i
中文摘要 ii
ABSTRACT v
CONTENTS viii
LIST OF TABLES ix
LIST OF FIGURES x
INTORDUCTION 1
METHODS AND MATERIALS 16
RESULTS 22
DISCUSSION 26
REFERENCES 51

LIST OF TABLES
TABLE 2-1 THE CATEGORIES OF DEPENDENT AND INDEPENDENT VARIABLES 20
TABLE 3-1 DEMOGRAPHIC CHARACTERISTICS OF INPATIENTS WITH AND WITHOUT DEMENTIA 30
TABLE 3-2 PREVALENCE OF PATIENT SAFETY EVENTS (‰) 32
TABLE 3-3A TOTAL ADVERSE EVENTS ASSOCIATED WITH DEMENTIA IN MULTILEVEL LOGISTIC REGRESSION MODEL 35
TABLE 3-3B MEDICAL/SURGICAL RELATED ADVERSE EVENTS ASSOCIATED WITH DEMENTIA IN MULTILEVEL LOGISTIC REGRESSION MODEL 37
TABLE 3-3C SURGICAL RELATED ADVERSE EVENTS ASSOCIATED WITH DEMENTIA IN MULTILEVEL LOGISTIC REGRESSION MODEL 39
TABLE 3-3D PSI03 PRESSURE ULCER ADVERSE EVENTS ASSOCIATED WITH DEMENTIA IN MULTILEVEL LOGISTIC REGRESSION MODEL 41
TABLE 3-4 ADVERSE EVENTS ASSOCIATED WITH DEMENTIA IN MULTILEVEL LOGISTIC REGRESSION MODEL, BY ACCREDITATION LEVEL 45
TABLE 3-5 ADVERSE EVENTS ASSOCIATED WITH DEMENTIA IN MULTILEVEL LOGISTIC REGRESSION MODEL, HOSPITAL OWNERSHIP 48
TABLE 3-6 RISK FACTORS OF ADVERSE EVENT AMONG DEMENTIA PATIENTS 49

LIST OF FIGURES
FIG. 2-1 CONCEPTUAL FRAMEWORK 16
FIG. 2-2 FLOWCHART OF SAMPLE SELECTION PROCESS 17
FIG. 3-1A PREVALENCE OF TOTAL PATIENT SAFETY EVENTS IN TAIWAN FROM 2010 TO 2013 33
FIG. 3-1B PREVALENCE OF MEDICAL/SURGICAL-RELATED PATIENT SAFETY EVENTS IN TAIWAN FROM 2010 TO 2013 33
FIG. 3-1C PREVALENCE OF SURGICAL-RELATED PATIENT SAFETY EVENTS IN TAIWAN FROM 2010 TO 2013 34
FIG. 3-1D PREVALENCE OF PRESSURE ULCER EVENTS IN TAIWAN FROM 2010 TO 2013 34
FIG. 3-2A PREVALENCE OF TOTAL ADVERSE EVENTS (‰), BY ACCREDITATION LEVEL 43
FIG. 3-2B PREVALENCE OF MEDICAL/SURGICAL RELATED ADVERSE EVENTS (‰), BY ACCREDITATION LEVEL 43
FIG. 3-2C PREVALENCE OF SURGICAL-RELATED ADVERSE EVENTS (‰), BY ACCREDITATION LEVEL 44
FIG. 3-2D PREVALENCE OF PRESSURE ULCER ADVERSE EVENTS (‰), BY ACCREDITATION LEVEL 44
FIG. 3-3A PREVALENCE OF TOTAL ADVERSE EVENTS (‰), BY HOSPITAL OWNERSHIP 46
FIG. 3-3B PREVALENCE OF MEDICAL/SURGICAL-RELATED ADVERSE EVENTS (‰), BY HOSPITAL OWNERSHIP 46
FIG. 3-3C PREVALENCE OF SURGICAL-RELATED ADVERSE EVENTS (‰), BY HOSPITAL OWNERSHIP 47
FIG. 3-3D PREVALENCE OF PRESSURE ULCER ADVERSE EVENTS (‰), BY HOSPITAL OWNERSHIP 47
1. Stichler, J.F., Patient safety as the number one priority in healthcare design. Herd, 2011. 5(1): p. 73-6.
2. Donaldson, M.S., J.M. Corrigan, and L.T. Kohn, To err is human: building a safer health system. Vol. 6. 2000: National Academies Press.
3. Donaldson, L., An organisation with a memory. Clinical Medicine, 2002. 2(5): p. 452-457.
4. Eisenberg, J., Statement on medical errors. Senate Appropriations Subcommittee on Labor Health and Human Services, and Education December, 1999. 13.
5. Thomas, E.J., et al., Costs of medical injuries in Utah and Colorado. Inquiry, 1999: p. 255-264.
6. Szlejf, C., et al., Medical adverse events in elderly hospitalized patients: a prospective study. Clinics, 2012. 67(11): p. 1247-1252.
7. Baker, G.R., et al., The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. Canadian medical association journal, 2004. 170(11): p. 1678-1686.
8. 顏如娟、許明暉(2008),論病人安全文化對醫療體系的衝擊,北市醫學雜誌,5(2),173-184。
9. Medicine, I.o., America's Health in Transition: Protecting and Improving Quality: a Statement of the Council of the Institute of Medicine. 1994: National Academies.
10. Australia. Taskforce on Quality in Australian Health, C., The final report of the Taskforce on Quality in Australian Health Care, June 1996, ed. C. Australian Health Ministers' Advisory. 1996, Canberra: Australian Health Ministers' Advisory Council.
11. Fong, T.G., et al., Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Annals of internal medicine, 2012. 156(12): p. 848-856.
12. Hu, C.J., et al., Postoperative adverse outcomes in surgical patients with dementia: a retrospective cohort study. World J Surg, 2012. 36(9): p. 2051-8.
13. Morrison, R.S. and A.L. Siu, A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. Journal of pain and symptom management, 2000. 19(4): p. 240-248.
14. Connolly, A., et al., Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review. Br J Gen Pract, 2013. 63(607): p. e88-96.
15. Blazina, L., L.T. MA, and E. Rubin, The behavior rating scale for dementia of the Consortium to Establish a Registry for Alzheimer’s Disease. Am J psychiatry, 1995. 152: p. 1349-1357.
16. Confederation, N., Acute Awareness: Improving hospital care for people with dementia. NHS Confederation, London, 2010.
17. Mega, M.S., et al., The spectrum of behavioral changes in Alzheimer's disease. Neurology, 1996. 46(1): p. 130-135.
18. 黃韻琴、洪玉馨、章甄凌、吳維珊、林均澄、徐海蓓、周文其(2010),失智症的安寧緩和照護,安寧療護雜誌,15(1),94-105。
19. Thomas, E.J., E.J. Orav, and T.A. Brennan, Hospital ownership and preventable adverse events. Journal of general internal medicine, 2000. 15(4): p. 211-219.
20. Vartak, S., M.M. Ward, and T.E. Vaughn, Do postoperative complications vary by hospital teaching status? Medical care, 2008: p. 25-32.
21. Indicators, A.Q., Guide to patient safety indicators. Rockville, MD: Agency for Healthcare Research and Quality, 2003.
22. WHO(2012), Programs and Projects-Patient Safety, from http://www.who.int/patientsafety/about/programmes/en/.
23. 病人安全資訊網(2016), 醫院病安目標, from http://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=655635445640513543.
24. Executive, N., The New NHS: Modern and Dependable. A National Framework for Assessing Performance: Consultation Document. 1998: Department of Health.
25. Johantgen, M., et al., Quality indicators using hospital discharge data: state and national applications. The Joint Commission journal on quality improvement, 1998. 24(2): p. 88-105.
26. Rivard, P.E., et al., Applying patient safety indicators (PSIs) across health care systems: achieving data comparability. 2005.
27. Romano, P.S., et al., A National Profile Of Patient Safety In U.S. Hospitals. Health Affairs, 2003. 22(2): p. 154-166.
28. Romano, P.S., et al., Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data. Health services research, 2009. 44(1): p. 182-204.
29. McLoughlin, V., et al., Selecting indicators for patient safety at the health system level in OECD countries. International Journal for quality in health care, 2006. 18(suppl 1): p. 14-20.
30. Miller, M.R., et al., Patient Safety Indicators: using administrative data to identify potential patient safety concerns. Health services research, 2001. 36(6 Pt 2): p. 110.
31. 台灣失智症協會(2016), from http://www.tada2002.org.tw/tada_know_02.html.
32. WHO(2016), Media centre-Dementia, from http://www.who.int/mediacentre/factsheets/fs362/en/
33. Prince, M.J., World Alzheimer Report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends. 2015.
34. Wolfson, C., et al., A reevaluation of the duration of survival after the onset of dementia. New England Journal of Medicine, 2001. 344(15): p. 1111-1116.
35. NIH(2011), Research and Funding- Global Health and Aging, from https://www.nia.nih.gov/research/publication/longer-lives-and-disability/burden-dementia
36. Rice, D.P., et al., Prevalence, costs, and treatment of Alzheimer's disease and related dementia: a managed care perspective. American Journal of Managed Care, 2001. 7(8): p. 809-820.
37. Eaker, E.D., et al., Alzheimer's disease or other dementia and medical care utilization. Annals of epidemiology, 2002. 12(1): p. 39-45.
38. Peng, D., Health promotion program on prevention of late onset dementia, from http://www.iagg.info/data/DU_-_Global_burden_of_dementia.pdf.
39. Comorbidity of mental disorders and physical conditions 2007. Canberra: AIHW. 2012.
40. Desai, M.M., et al., Receipt of nutrition and exercise counseling among medical outpatients with psychiatric and substance use disorders. J Gen Intern Med, 2002. 17(7): p. 556-60.
41. Druss, B.G., et al., Mental disorders and use of cardiovascular procedures after myocardial infarction. Jama, 2000. 283(4): p. 506-511.
42. Jones, L.E., W. Clarke, and C.P. Carney, Receipt of diabetes services by insured adults with and without claims for mental disorders. Medical care, 2004. 42(12): p. 1167-1175.
43. Brown, S., B. Barraclough, and H. INSKIP, Causes of the excess mortality of schizophrenia. The British journal of psychiatry, 2000. 177(3): p. 212-217.
44. Chang, C.-K., et al., All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study. BMC psychiatry, 2010. 10(1): p. 77.
45. Saha, S., D. Chant, and J. McGrath, A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of general psychiatry, 2007. 64(10): p. 1123-1131.
46. Li, Y., et al., Adverse hospital events for mentally ill patients undergoing coronary artery bypass surgery. Health Serv Res, 2008. 43(6): p. 2239-52.
47. Daumit, G.L., et al., Adverse events during medical and surgical hospitalizations for persons with schizophrenia. Arch Gen Psychiatry, 2006. 63(3): p. 267-72.
48. Smith, E.G., S. Zhao, and A.K. Rosen, Using the patient safety indicators to detect potential safety events among US veterans with psychotic disorders: clinical and research implications. Int J Qual Health Care, 2012. 24(4): p. 321-9.
49. Druss, B.G., et al., Quality of medical care and excess mortality in older patients with mental disorders. Archives of general psychiatry, 2001. 58(6): p. 565-572.
50. Weiss, A.P., et al., Treatment of cardiac risk factors among patients with schizophrenia and diabetes. Psychiatr Serv, 2006. 57(8): p. 1145-52.
51. Desai, M.M., et al., Mental disorders and quality of diabetes care in the veterans health administration. Am J Psychiatry, 2002. 159(9): p. 1584-90.
52. Dixon, L.B., et al., A comparison of type 2 diabetes outcomes among persons with and without severe mental illnesses. Psychiatr Serv, 2004. 55(8): p. 892-900.
53. Lin, E.H., et al., Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care, 2004. 27(9): p. 2154-60.
54. Lawrence, D.M., et al., Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980-1998. The British journal of psychiatry, 2003. 182(1): p. 31-36.
55. Zekry, D., et al., Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients. Int J Geriatr Psychiatry, 2009. 24(3): p. 283-91.
56. Goodwin, J.S., et al., Risk of continued institutionalization after hospitalization in older adults. J Gerontol A Biol Sci Med Sci, 2011. 66(12): p. 1321-7.
57. Lang, P.O., et al., Early markers of prolonged hospital stay in demented inpatients: A multicentre and prospective study. The journal of nutrition, health & aging, 2009. 14(2): p. 141-147.
58. Sampson, E.L., et al., Differences in care received by patients with and without dementia who died during acute hospital admission: a retrospective case note study. Age and ageing, 2006. 35(2): p. 187-189.
59. Muther, J., et al., Are patients with dementia treated as well as patients without dementia for hypertension, diabetes, and hyperlipidaemia? Br J Gen Pract, 2010. 60(578): p. 671-4.
60. Sloan, F.A., et al., The effect of dementia on outcomes and process of care for Medicare beneficiaries admitted with acute myocardial infarction. Journal of the American Geriatrics Society, 2004. 52(2): p. 173-181.
61. Chodosh, J., et al., Caring for patients with dementia: how good is the quality of care? Results from three health systems. Journal of the American Geriatrics Society, 2007. 55(8): p. 1260-1268.
62. Guijarro, R., et al., Impact of dementia on hospitalization. Neuroepidemiology, 2010. 35(2): p. 101-8.
63. Druss, B.G., et al., Mental comorbidity and quality of diabetes care under Medicaid: a 50-state analysis. Medical care, 2012. 50(5): p. 428.
64. Laroche, M.L., et al., Adverse drug reactions in patients with Alzheimer's disease and related dementia in France: a national multicentre cross‐sectional study. Pharmacoepidemiology and drug safety, 2013. 22(9): p. 952-960.
65. Druss, B.G., et al., Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Medical care, 2011. 49(6): p. 599-604.
66. Jensen, P.H., E. Webster, and J. Witt, Hospital type and patient outcomes: an empirical examination using AMI readmission and mortality records. Health Econ, 2009. 18(12): p. 1440-60.
67. Druss, B.G., Improving medical care for persons with serious mental illness: challenges and solutions. The Journal of clinical psychiatry, 2006. 68: p. 40-44.
68. 鍾其祥、高森永、簡戊鑑(2010),臺灣地區住院醫療疏失案件流行病學分析: 以 2007 年為例,醫務管理期刊,11(3),59-74。
69. 邱幼華(2011),探討台灣病人安全之情形--運用AHRQ病人安全指標(碩士論文),國立陽明大學醫務管理研究所碩士論文。
70. Wang, C.H., et al., Epidemiology of medical adverse events: perspectives from a single institute in Taiwan. J Formos Med Assoc, 2016. 115(6): p. 434-9.
71. Chodosh, J., et al., Caring for patients with dementia: how good is the quality of care? Results from three health systems. J Am Geriatr Soc, 2007. 55(8): p. 1260-8.
72. Rowland, K.J., et al., Surgical futility: “Aggressive” surgery on the severely demented. Surgery, 2009. 145(4): p. 351-354.
73. Batsch, N.L. and M.S. Mittelman, World Alzheimer Report 2012. Overcoming the stigma of dementia. Alzheimer's Disease International http://www. alz. org/documents_custom/world_report_2012_final. pdf, 2012.
74. KathyKastner(2015), Dementia: Feeding tubes may add to risk of bed sores, from http://www.bestendings.com/feeding-tubes-may-add-risk-pressure-ulcers/.
75. Bahl, V., et al., Do the AHRQ patient safety indicators flag conditions that are present at the time of hospital admission? Medical care, 2008. 46(5): p. 516-522.
76. Glance, L.G., et al., Impact of date stamping on patient safety measurement in patients undergoing CABG: Experience with the AHRQ Patient Safety Indicators. BMC Health Services Research, 2008. 8(1): p. 176.
77. Houchens, R.L., A. Elixhauser, and P.S. Romano, How often are potential patient safety events present on admission? Jt Comm J Qual Patient Saf, 2008. 34(3): p. 154-63.
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