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Abstract：
BACKGROUND: The burden of patient safety incidents (PSIs) is often characterized by their impact on mortality, morbidity, and treatment costs. Few studies have attempted to estimate the impact of PSIs on patients\' health-related quality of life (HRQoL) and the studies that have made such estimates primarily focus on a narrow set of incidents. The aim of this paper is to estimate the impact of PSIs on HRQoL of patients undergoing elective hip and knee surgery in England.
METHODS: A unique linked longitudinal data set consisting of patient-reported outcome measures for patients with hip and knee replacements linked to Hospital Episode Statistics (HES) collected between 2013/14 and 2016/17 was examined. Patients with any of nine US Agency for Healthcare Research and Quality (AHRQ) PSI indicators were identified. HRQoL was measured using the general EuroQol five dimensions questionnaire (EQ-5D) before and after surgery. Exploiting the longitudinal structure of the data, exact matching was combined with difference in differences to estimate the impact of experiencing a PSI on HRQoL and its individual dimensions, comparing HRQoL improvements after surgery in similar patients with and without a PSI in a retrospective cohort study. This design compares the change in HRQoL before and after surgery in patients who experience a PSI to those who do not.
RESULTS: The sample comprised 190 697 and 204 649 observations for patients undergoing hip replacement and knee replacement respectively. For six out of nine PSIs, patients who experienced a PSI reported improvements in HRQoL that were 14-23% lower than those who did not experience a PSI during surgery. Those who experienced a PSI were also more likely to report worse health states after surgery than those without a PSI on all five dimensions of HRQoL.
CONCLUSIONS: PSIs are associated with a substantial negative impact on patients\' HRQoL.
METHODS: A unique linked longitudinal data set consisting of patient-reported outcome measures for patients with hip and knee replacements linked to Hospital Episode Statistics (HES) collected between 2013/14 and 2016/17 was examined. Patients with any of nine US Agency for Healthcare Research and Quality (AHRQ) PSI indicators were identified. HRQoL was measured using the general EuroQol five dimensions questionnaire (EQ-5D) before and after surgery. Exploiting the longitudinal structure of the data, exact matching was combined with difference in differences to estimate the impact of experiencing a PSI on HRQoL and its individual dimensions, comparing HRQoL improvements after surgery in similar patients with and without a PSI in a retrospective cohort study. This design compares the change in HRQoL before and after surgery in patients who experience a PSI to those who do not.
RESULTS: The sample comprised 190 697 and 204 649 observations for patients undergoing hip replacement and knee replacement respectively. For six out of nine PSIs, patients who experienced a PSI reported improvements in HRQoL that were 14-23% lower than those who did not experience a PSI during surgery. Those who experienced a PSI were also more likely to report worse health states after surgery than those without a PSI on all five dimensions of HRQoL.
CONCLUSIONS: PSIs are associated with a substantial negative impact on patients\' HRQoL.
摘要：
背景：患者安全事件（PSIs）的负担通常以对死亡率的影响为特征，发病率，和治疗费用。很少有研究试图估计PSIs对患者健康相关生活质量（HRQoL）的影响，并且进行此类估计的研究主要集中在一组狭窄的事件上。本文的目的是评估PSI对英格兰择期髋和膝关节手术患者HRQoL的影响。
方法：检查了一个独特的关联纵向数据集，该数据集包括2013/14至2016/17年间收集的患者报告的与医院事件统计（HES）相关的髋关节和膝关节置换患者的结局指标。确定了具有9个美国医疗保健研究和质量机构（AHRQ）PSI指标的患者。HRQoL使用通用EuroQol五维度问卷（EQ-5D）在手术前后进行测量。利用数据的纵向结构，精确匹配与差异差异相结合，以估计经历PSI对HRQoL及其个体维度的影响，在一项回顾性队列研究中,比较有和无PSI的相似患者术后HRQoL改善情况.此设计比较了经历PSI的患者与未经历PSI的患者手术前后HRQoL的变化。
结果：该样本分别包含190.697和204.649观察结果，分别用于髋关节置换和膝关节置换患者。对于九个PSI中的六个，经历过PSI的患者报告的HRQoL改善比手术期间未经历PSI的患者低14-23%.在HRQoL的所有五个维度上，与没有PSI的人相比，经历过PSI的人在手术后更有可能报告更差的健康状况。
结论：PSIs对患者的HRQoL有显著的负面影响。
方法：检查了一个独特的关联纵向数据集，该数据集包括2013/14至2016/17年间收集的患者报告的与医院事件统计（HES）相关的髋关节和膝关节置换患者的结局指标。确定了具有9个美国医疗保健研究和质量机构（AHRQ）PSI指标的患者。HRQoL使用通用EuroQol五维度问卷（EQ-5D）在手术前后进行测量。利用数据的纵向结构，精确匹配与差异差异相结合，以估计经历PSI对HRQoL及其个体维度的影响，在一项回顾性队列研究中,比较有和无PSI的相似患者术后HRQoL改善情况.此设计比较了经历PSI的患者与未经历PSI的患者手术前后HRQoL的变化。
结果：该样本分别包含190.697和204.649观察结果，分别用于髋关节置换和膝关节置换患者。对于九个PSI中的六个，经历过PSI的患者报告的HRQoL改善比手术期间未经历PSI的患者低14-23%.在HRQoL的所有五个维度上，与没有PSI的人相比，经历过PSI的人在手术后更有可能报告更差的健康状况。
结论：PSIs对患者的HRQoL有显著的负面影响。
