Frequency of ambulatory care adverse events in Latin American countries: the AMBEAS/PAHO cohort study
Dolors Montserrat-CapellaM L Buelga SuarezLidia OrtízJosé Joaquín MiraHernando Gaitán-DuarteLudovic Revéizon behalf of the AMBEAS GroupM. ChoHector P. RodríguezMatías MilbergMarta DiéguezMichael P. TristanRosario I. GranadosBarrOs PuertasOsvaldo ArtazaD. A. A. VarellaJohn FitzGeraldF. H. TorresC. IglesiasL. H. L. GarciaRaquel da Silva LimaSebastián Andrés MuñozDaniela Cunha de OliveiraMercedes ValdesBegoña SagastuyJ. San Martín VarelaFilomena SousaFabíola Isabel Suano de SouzaRenee E. Torres
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Determine the frequency and preventability of adverse events (AEs) from available information sources in selected ambulatory care (AC) sites in Latin America (LA). Multinational observational cohort was conducted to determine the period prevalence (retrospective focus) and the cumulative incidence (prospective focus) of AEs. Outpatient clinics in Mexico, Peru, Brazil and Colombia. A random selection of 2080 patients. The existence of AE was decided based on trigger information provided by the patient and crossing the data with each patient's medical history. AE occurrences 6 months prior (prevalence) and 42 days after (incidence) the patient receiving AC were identified. AE type and preventability were also described. Two thousand eighty patients participated in the study. AEs prevalence was 5.2% (108/2080) [95% confidence interval (CI) 4.2–6.1%], and cumulative incidence was 2.4% (42/1757) (95% CI 1.7–3.1%). AEs considered preventable were 44% (55/108) of prevalence period, and 52.4% (22/42) of incidence period. Preventability was associated with patient socioeconomic status (OR 3.5, 95% CI 1.4–8.8), medication error (OR 0.1, 95% CI 0.0–0.4), diagnostic error (OR 0.1, 95% CI 0.0–0.8) and a minor impact on the patient (OR 0.2 95% CI 0.1–0.9). The frequency of AE in ambulatory settings in LA is in the high-frequency range of research focused on the prevalence of AEs. Fifty percent was preventable. This study provides an approach for assessing the frequency and preventability of AE in order to enhance patient safety in LA.This report describes medications provided or prescribed during ambulatory medical care visits in 1992. Total ambulatory care medication therapy combines data from office-based physicians, hospital outpatient departments (OPD's), and hospital emergency departments (ED's). Drug therapy is described along three dimensions: number of drugs provided or prescribed (drug mention), whether a visit had any drugs mentioned (drug visit), and average number of drugs mentioned per 100 visits (drug mention rate). Utilization in ambulatory care settings is compared in terms of patient, drug, provider, and visit characteristics.Annual use of medication therapy was determined using data collected in the 1992 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). NAMCS includes office visits to nonfederal physicians principally engaged in office practice. The target universe of NHAMCS includes visits to ED's and OPD's of non-Federal, short-stay, or general hospitals. Sample data were weighted to produce annual estimates. Drug mentions are defined as the number of drugs mentioned on the patient record from.An estimated 1.1 billion medications were provided or prescribed at ambulatory care visits in 1992. The setting with the greatest percent of visits with medication therapy was the ED; OPD's had the lowest percent with medications. Patients at the ED were provided more pain relief type drugs. The rate of drug mentions and percent of visits with medications were significantly higher in OPD clinics of general medicine and pediatrics compared with other types of OPD clinics. In office-based settings, physicians specializing in cardiovascular diseases were most likely to prescribe medications. Also, cardiovascular-renal type drugs accounted for the largest percent of office-based drug mentions. Visits with illness diagnoses are most likely to receive medication therapy. Trend data comparing 1980 to 1992 office-based mentions showed significant changes on several characteristics: single-ingredient drug status, physician specialty, and patient age.The profile of patients using office- and hospital-based ambulatory care settings are quite different as is the case-mix of conditions. These differences play an important role in medications utilized. The aging of the U.S. population from 1980 to 1992 appeared to have significant effects on several drug mention characteristics.
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This article describes Ambulatory Visit Groups (AVGs) and the process by which they were defined. An approach to the analysis of physician productivity in the ambulatory setting is then demonstrated, with data derived from the National Ambulatory Medical Care Survey [1]. Finally, recommendations for future work are presented to make this approach more effective in designing and managing ambulatory care delivery organizations.
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This report describes ambulatory care visits in the United States across three ambulatory care settings-physician offices, hospital outpatient departments, and hospital emergency departments. Statistics are presented on selected patient and visit characteristics for aggregated ambulatory care visits and for each setting.The data presented in this report were collected by means of the 1995 National Ambulatory Medical Care Survey (NAMCS) and the 1995 National Hospital Ambulatory Medical Care Survey (NHAMCS). These surveys are part of the ambulatory care component of the National Health Care Survey that measures health care utilization across a variety of providers. The NAMCS and NHAMCS are national probability sample surveys of visits to office-based physicians (NAMCS) and visits to the outpatient departments and emergency departments of non-Federal, short-stay and general hospitals (NHAMCS) in the United States. Sample data are weighted to produce annual estimates.During 1995 an estimated 860.9 million visits were made to physician offices, hospital outpatient departments, and hospital emergency departments in the United States, an overall rate of 3.3 visits per person. Visits to office-based physicians accounted for 81.0 percent of ambulatory care utilization, followed by visits to emergency departments (11.2 percent) and outpatient departments (7.8 percent). Persons 75 years and over had the highest rate of ambulatory care visits. Females had significantly higher rates of visits to physician offices and hospital outpatient departments than males did. Less than two-thirds of ambulatory care visits by black persons were to physician offices. There were an estimated 126.1 million injury-related ambulatory care visits during 1995, or 48.2 visits per 100 persons.
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Abstract Aim With the increased need to manage patients out of hospital during COVID-19, it was anticipated that need for ambulatory imaging would increase. This study aimed to assess the demand for ambulatory ultrasounds (US) during the COVID-19 pandemic and the impact on inpatient admissions. Methods A retrospective review of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required an US as first line imaging. Electronic Care Records were used to collect data regarding type of US i.e., inpatient, or ambulatory, time taken for ambulatory US and outcome after imaging. The same period in 2019 was assessed for comparison. Results In 2020, 100 patients required an US compared to 88 in 2019. 37% (37/100) of which were discharged for an ambulatory US, compared to 14.8% (13/88) in 2019 (p = 0.006). The average waiting time for an ambulatory US in 2019 was 2 days, this increased to 7 days in 2020. Following ambulatory US in 2020 43.2% (16/37) required further outpatient imaging or assessment; similar outcomes were seen in 2019 with 46.2% (6/13). Overall, there was a 150% increase in the use of ambulatory US, with a 26% decrease in admissions in 2020 vs. 2019. Conclusions There was a significant increase in the number of patients discharged from ED to undergo an ambulatory US resulting in reduced inpatient admissions. This increase in demand is reflected by the prolonged waiting time highlighting the requirement for expansion of ambulatory services to meet this clinical need.
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In preparation for an ambulatory care prospective payment system, the Health Care Financing Administration (HCFA), Office of Research and Demonstration, supported a two-year grant project at Yale University for further development of an ambulatory patient classification system based on Ambulatory Visit Groups (AVGs). This article explains the premises of the study and gives us insight into what we may ultimately expect in an ambulatory care prospective payment system.
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During the last decade, Chile's private health sector has experienced a dramatic increase in hospitalization rates, growing at four times the rate of ambulatory visits. Such evolution has raised concern among policy-makers. We studied the effect of ambulatory and hospital co-insurance rates on hospitalizations for ambulatory care sensitive conditions (ACSC) among individuals with private insurance in Chile. We used a large administrative dataset of private insurance claims for the period 2007-8 and a final sample of 2,792,662 individuals to estimate a structural model of two equations. The first equation was for ambulatory visits and the second for future hospitalizations for ACSC. We estimated the system by Two Stage Least Squares (2SLS) corrected by heteroskedasticity via Generalized Method of Moments (GMM) estimation. Results show that increased ambulatory visits reduced the probability of future hospitalizations, and increased ambulatory co-insurance decreased ambulatory visits for the adult population (19-65 years-old). Both findings indicate the need to reduce ambulatory co-insurance as a way to reduce hospitalizations for ACSC. Results also showed that increasing hospital co-insurance does have a statistically significant reduction on hospitalizations for the adult group, while it does not seem to have a significant effect on hospitalizations for the children (1-18 years-old) group. This paper's contribution is twofold: first, it shows how the level of co-insurance can be a determinant in avoiding unnecessary hospitalizations for certain conditions; second, it highlights the relevance for policy-making of using data on ACSC to improve the efficiency of health systems by promoting ambulatory care as well as population health.
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