Abstract TP316: Appraising the Quality of Patient Care in Hospitalization for Transient Ischemic Attack
Introduction: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital-acquired conditions (HACs) are federally implemented quality metrics. The necessity of hospitalization for transient ischemic attack (TIA) remains controversial. Here, we report the incidence, risk factors, and in-hospital outcomes associated with HACs and PSIs in this population.
Methods: The Nationwide Inpatient Sample (2002-2011) was queried for all records coded as primary diagnoses of TIA. The impact of demographics, insurance status, comorbidities, and in-hospital procedures on the occurrence of PSIs and HACs and the effect of these events on length of stay (LOS), hospital costs, and mortality was examined in bivariate and multivariate analyses.
Results: A total of 52,969 PSIs and 21,612 HACs were identified among 2,117,247 TIA hospitalizations. The most frequent PSIs were pressure ulcers (1,173 per 100,000 patients), deep vein thrombosis (376 per 100,000 patients), and respiratory failure (329 per 100,000 patients) while the most frequent HACs were falls/trauma (942 per 100,000 patients), poor glycemic control (33 per 100,000 patients), and stage III/IV pressure ulcers (31 per 100,000 patients). In adjusted analyses, age 85+ (odds ratios [ORs]: 3.81, 1.50), Medicare (ORs: 1.62, 1.37), Medicaid (ORs: 2.01, 1.34), and 3+ comorbidities (ORs: 2.83, 1.30) were independent predictors of PSI or HAC occurrence, respectively (all p<0.0001). Adjusted risk factors of PSI occurrence included: black race (OR: 1.21), in-hospital ischemic stroke (OR: 1.97), thrombolytic therapy (OR: 2.54), coronary angioplasty (OR: 1.81), and coronary artery bypass graft (OR: 7.18) (all p<0.0001). PSI or HAC in TIA patients independently predicted prolonged LOS, increased total costs, and adverse discharges (all p<0.0001). In TIA patients suffering a PSI or HAC, odds of mortality were increased by factors of 30.1 and 4.08, respectively (all p<0.0001).
Conclusion: Among TIA hospitalizations, patient age, race, payer status, pre-existing comorbidity, hospital characteristics, and procedural management significantly impact the occurrence of PSIs and HACs, further affecting patient outcomes.
Author Disclosures: K. Rumalla: None. A.Y. Reddy: None. A. Rajan: None. M.K. Mittal: None.
- © 2016 by American Heart Association, Inc.