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Importance: Patient safety is a US national priority, yet lacks a comprehensive assessment of progress over the past decade.Objective: To determine the change in the rate of adverse events in hospitalized patients.Design, Setting, and Participants: This serial cross-sectional study used data from the Medicare Patient Safety Monitoring System from 2010 to 2019 to assess in-hospital adverse events in patients. The study included 244 542 adult patients hospitalized in 3156 US acute care hospitals across 4 condition groups from 2010 through 2019: acute myocardial infarction (17%), heart failure (17%), pneumonia (21%), and major surgical procedures (22%); and patients hospitalized from 2012 through 2019 for all other conditions (22%).Exposures: Adults aged 18 years or older hospitalized during each included calendar year.Main Outcomes and Measures: Information on adverse events (abstracted from medical records) included 21 measures across 4 adverse event domains: adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events (hospital-acquired pressure ulcers and falls). The outcomes were the total change over time for the observed and risk-adjusted adverse event rates in the subpopulations.Results: The study sample included 190 286 hospital discharges combined in the 4 condition-based groups of acute myocardial infarction, heart failure, pneumonia, and major surgical procedures (mean age, 68.0 [SD, 15.9] years; 52.6% were female) and 54 256 hospital discharges for the group including all other conditions (mean age, 57.7 [SD, 20.7] years; 59.8% were female) from 3156 acute care hospitals across the US. From 2010 to 2019, the total change was from 218 to 139 adverse events per 1000 discharges for acute myocardial infarction, from 168 to 116 adverse events per 1000 discharges for heart failure, from 195 to 119 adverse events per 1000 discharges for pneumonia, and from 204 to 130 adverse events per 1000 discharges for major surgical procedures. From 2012 to 2019, the rate of adverse events for all other conditions remained unchanged at 70 adverse events per 1000 discharges. After adjustment for patient and hospital characteristics, the annual change represented by relative risk in all adverse events per 1000 discharges was 0.94 (95% CI, 0.93-0.94) for acute myocardial infarction, 0.95 (95% CI, 0.94-0.96) for heart failure, 0.94 (95% CI, 0.93-0.95) for pneumonia, 0.93 (95% CI, 0.92-0.94) for major surgical procedures, and 0.97 (95% CI, 0.96-0.99) for all other conditions. The risk-adjusted adverse event rates declined significantly in all patient groups for adverse drug events, hospital-acquired infections, and general adverse events. For patients in the major surgical procedures group, the risk-adjusted rates of events after a procedure declined significantly.Conclusions and Relevance: In the US between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions. Further research is needed to understand the extent to which these trends represent a change in patient safety. [ABSTRACT FROM AUTHOR]

Fifth, consistent with the OIG report, our study[1] demonstrated that patient safety remains a serious concern and improvements are necessary. Comment & Response B In Reply b In response to the OIG's letter about our article,[1] which concluded that there was a significant decrease in the rates of adjusted adverse events for hospital patients between 2010 and 2019, we agree that too many adverse events occurred, and efforts should be focused on lowering their frequency. First, in their 2022 report,[2] the OIG noted that its "sample size was insufficient to effectively compare the results of this report to the harm rates identified in the 2010 report", with each of the 2 OIG reports including 700 to 800 medical records. [Extracted from the article]

They stated that "If the goal is zero harms, research should test whether adverse event outcomes are significantly closer to zero rather than how the trends in adverse event outcomes compare with 2010 rates, or at least rates meaningful to patients such as a 50% rate reduction - a median that none of the adverse event rates crossed."[1] Although no group of patients had an overall adverse event rate reduced by 50% in our study,[2] the observed data showed reductions ranging from 31% to 39% for the 4 condition-based patient groups (from 2010 to 2019); in the risk-adjusted data, the relative risk of experiencing 1 or more adverse events per hospitalization was reduced by 35% to 45% at the patient level (eFigure 2A in the article's Supplement).[2] For the all other conditions group, no adverse event rate reduction was seen in the observed data (2012 to 2019), but the relative risk was reduced by 19% after risk adjustment for 1 or more adverse events per hospitalization. Comment & Response B To the Editor b I have some concerns about the Editorial[1] that was written about our recent article.[2] First, the Editorial stated that "...patients may be less convinced that risk-adjusted annual declines of 6% in the rates of acute myocardial infarction or pneumonia, for instance, imply that hospitals are adequately safer today."[1] However, our study[2] did not address findings related to the rates of acute myocardial infarction or report a decrease of 6% in pneumonia. We addressed adverse events experienced by 5 groups of patients, and 2 of the 5 groups were patients with acute myocardial infarction and pneumonia. [Extracted from the article]

The article presents a study on the trends in the Medicare Patient Safety Monitoring System (MPSMS) ventilator-associated pneumonia (VAP) rates in the U.S. from 2005 to 2013. Also cited are the decreasing incidence of VAP from 2006 to 2012 as reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN), and the participants in the study, particularly the older patients with principal diagnosis of heart failure and similar ailments.

The article discusses research which investigated changes in adverse events in Medicare patients hospitalized in the U.S. between the period 2005 and 2011 for common conditions. Aside from rate of occurrence, the study focused on proportion of patients per adverse event for cases including acute myocardial infarction, congestive heart failure, and pneumonia. Topics explored also include patient safety-related challenges and link between adverse events and in-hospital mortality.

Population densities are almost without exception calculated using gross area data. This paper calculates densities using a measure of residential area and reports on the statistically preferred areal unit. [ABSTRACT FROM PUBLISHER]