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BMC Health Services Research
Published in: BMC Health Services Research 1/2011

Open Access 01-12-2011 | Research article

Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data

Authors: Jürgen Stausberg, Joerg Hasford

Published in: BMC Health Services Research | Issue 1/2011

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Abstract

Background

Adverse reactions and medication errors are complications of drug use. Spontaneous reporting systems and pharmacoepidemiological studies incompletely detect the occurrence of these events in daily hospital care. In this study, the frequency and type of drug-related admissions and hospital-acquired adverse drug events (ADE) in Germany were assessed using routinely collected hospital data.

Methods

The study was based on aggregated hospital routine data covering the period 2003 to 2007 and annually recorded as part of the further development of the German Diagnosis-Related Groups. The 505 ICD-10-codes indicating an ADE were categorized in seven groups according to their certainty. Primary diagnoses were considered as a proxy for drug-related admissions, and secondary diagnoses as a proxy for hospital-acquired ADE.

Results

Among all hospital admissions, 5% were found to be at least possibly drug-induced and 0.7% very likely drug-induced. There was a significant increase in the overall rate of drug-related admissions over time (p < 0.038). Enterocolitis due to Clostridium difficile infection was the most frequent cause of a drug-related admission. About 4.5% of in-patients had experienced a hospital-acquired ADE. In addition, over the course of the study period, the overall frequency of hospital-acquired ADEs significantly increased (p < 0.001).

Conclusions

In Germany, more than 5% of hospital episodes are either caused or complicated by an ADE. Between 2003 and 2007, there was a statistically significant increase in the overall rate and in some of the subcategories defined by the list of ICD-10-codes suspected to be indicative of an ADE. Before the use of routine data in pharmacovigilance and patient safety can be fully exploited, a further tailoring of both the ICD and the available variable set is needed.
Appendix
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Literature
1.
Muehlberger N, Schneeweiss S, Hasford J: Adverse drug reaction monitoring - cost and benefit considerations. Part I: frequency of adverse drug reactions causing hospital admission. Pharmacoepidemiol Drug Saf. 1997, 6 (Suppl 3): S71-77.CrossRefPubMed
2.
Lazarou J, Pomeranz BH, Corey PN: Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998, 279: 1200-1205. 10.1001/jama.279.15.1200.CrossRefPubMed
3.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Brickenridge AM: Adverse drug reactions as cause of admission to hospital: a prospective analysis of 18820 patients. BMJ. 2004, 329: 15-19. 10.1136/bmj.329.7456.15.CrossRefPubMedPubMedCentral
4.
Kongkaew C, Noyce PR, Ashcroft DM: Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008, 42: 1017-1025. 10.1345/aph.1L037.CrossRefPubMed
5.
Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M: Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS ONE. 2009, 4: e4439-10.1371/journal.pone.0004439.CrossRefPubMedPubMedCentral
6.
Schneeweiss S, Hasford J, Göttler M, Hoffmann A, Riethling AK, Avorin J: Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol. 2002, 58: 285-291. 10.1007/s00228-002-0467-0.CrossRefPubMed
7.
Goettler M, Schneeweiss S, Hasford J: Adverse drug reaction monitoring - cost and benefit considerations. Part II: cost and preventability of adverse drug reactions leading to hospital admission. Pharmacoepidemiol Drug Saf. 1997, 6 (Suppl 3): S79-90.CrossRefPubMed
8.
Kohn LT, Corrigan JM, Donaldson MS, Eds: To err is human. Building a safer health system. 1999, Washington, Institute of Medicine: National Academy Press, 312.
9.
Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L: The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999, 6: 313-321. 10.1136/jamia.1999.00660313.CrossRefPubMedPubMedCentral
10.
Kaushal R, Shojania KG, Bates DW: Effects of computerized physician order entry and clinical decision support systems on medication safety. Arch Intern Med. 2003, 163: 1409-1416. 10.1001/archinte.163.12.1409.CrossRefPubMed
11.
Kuperman GJ, Gibson RF: Computer physician order entry: benefits, costs, and issues. Ann Intern Med. 2003, 139: 31-39.CrossRefPubMed
12.
Edwards IR: The future of pharmacovigilance: a personal view. Eur J Clin Pharmacol. 2008, 64: 173-181. 10.1007/s00228-007-0435-9.CrossRefPubMed
13.
Furu K, Wettermark B, Andersen M, Martikainen JE, Almarsdottir AB, Sørensen HT: The Nordic countries as a cohort for pharmacoepidemiological research. Basic Clin Pharmacol Toxicol. 2010, 106: 86-94. 10.1111/j.1742-7843.2009.00494.x.CrossRefPubMed
14.
Johansson S, Wallander MA, de Abajo FJ, García Rodríguez LA: Prospective drug safety monitoring using the UK primary-care General Practice Research Database: theoretical framework, feasibility analysis and extrapolation to future scenarios. Drug Saf. 2010, 33: 223-232. 10.2165/11319010-000000000-00000.CrossRefPubMed
15.
Rosati K: Using electronic health information for pharmacovigilance: the promise and the pitfalls. J Health Life Sci Law. 2009, 2: 173-239.
16.
Williams D, Feely J: Underreporting of adverse drug reactions: Attitudes of Irish doctors. Irish Journal of Medical Science. 1999, 168: 257-261. 10.1007/BF02944353.CrossRefPubMed
17.
Raschetti R, Morgutti M, Menniti-Ippolito F, Belisari A, Rossignoli A, Longhini P, La Guidara C: Suspected adverse drug events requiring emergency department visits or hospital admissions. European Journal of Clinical Pharmacology. 1999, 54: 959-963. 10.1007/s002280050582.CrossRefPubMed
18.
Hopf Y, Watson M, Williams D: Adverse-drug-reaction related admissions to a hospital in Scotland. Pharmacy World & Science. 2008, 30: 854-862. 10.1007/s11096-008-9240-5.CrossRef
19.
Kane R, Wellings K, Free C, Goodrich J: Uses of routine data sets in the evaluation of health promotion interventions: opportunities and limitations. Health Education. 2000, 100: 33-41. 10.1108/09654280010309030.CrossRef
20.
Solberg LI, Hurley JS, Roberts MH, Nelson WW, Frost FJ, Crain AL, Gunter MJ, Young LR: Measuring patient safety in ambulatory care: potential for identifying medical group drug-drug interaction rates using claims data. Am J Manag Care. 2004, 10: 753-759.PubMed
21.
Waller P, Shaw M, Ho D, Shakir S, Ebrahim S: Hospital admissions for 'drug-induced' disorders in England: a study using the Hospital Episodes Statistics (HES) database. British Journal of Clinical Pharmacology. 2004, 59: 213-219.CrossRef
22.
Wu TY, Jen MH, Bottle A, Molokhia M, Aylin P, Bell D, Majeed A: Ten-year trends in hospital admissions for adverse drug reactions in England 1999-2009. J R Soc Med. 2010, 103: 239-250. 10.1258/jrsm.2010.100113.CrossRefPubMedPubMedCentral
23.
Hougland P, Nebeker J, Pickard S, Van Tuinen M, Masheter C, Elder S, Williams S, Xu W: Using ICD-9-CM codes in hospital claims data to detect adverse events in patient safety surveillance. Advances in patient safety: new directions and alternative approaches (Vol 1: Assessment). Edited by: Battles JB, Keyes MA, Grady ML. 2008, Rockville (MD): Agency for Healthcare Research and Quality
24.
Stausberg J, Hasford J: Identification of adverse drug events: the use of ICD-10 coded diagnoses in routine hospital data. Dtsch Arztebl Int. 2010, 107: 23-29.PubMedPubMedCentral
25.
Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel S, Sweitzer BJ, Seha BF, Hallisey R, van der Vliet M, Nemeskal R, Leape LL, for the ADE Prevention Study Group: Incidence of adverse drug events and potential adverse drug events. Implications for prevention. JAMA. 1995, 274: 29-34. 10.1001/jama.274.1.29.CrossRefPubMed
26.
Morimoto T, Gandhi TK, Seger AC, Hsieh TC, Bates DW: Adverse drug events and medication errors: detection and classification methods. Qual Saf Health Care. 2004, 13: 306-314. 10.1136/qshc.2004.010611.CrossRefPubMedPubMedCentral
27.
WHO: International drug monitoring: the role of national centers. Technical Report Series No 498. 1972, Geneva: World Health Organisation
28.
Zhang M, Holman CDAJ, Preen DB, Brameld K: Repeat adverse drug reactions causing hospitalization in older Australians: a population-based longitudinal study 1980-2003. Br J Clin Pharmacol. 2006, 63: 163-170.CrossRefPubMedCentral
29.
Nebeker JR, Yarnold PR, Soltysik RC, Sauer BC, Sims S, Samore MH, Rupper RW, Swanson KM, Saritz LA, Shingle J, Wu X: Developing indicators of inpatient drug events through nonlinear analysis using administrative data. Medical Care. 2007, 45: 81-88. 10.1097/MLR.0b013e3180616c2c.CrossRef
30.
Deutsche Krankenhausgesellschaft, Spitzenverbände der Krankenkassen, Verband der privaten Krankenversicherung, Institut für das Entgeltsystem im Krankenhaus: Allgemeine und Spezielle Kodierrichtlinien für die Verschlüsselung von Krankheiten und Prozeduren, Version 2006. Institut für das Entgeltsystem im Krankenhaus. 2005, [General and special standards for coding of diseases and procedures, version 2006]
31.
Houchens RL, Elixhauser A, Romano PS: How often are potential patient safety events present on admission?. The Joint Commission Journal on Quality and Patient Safety. 2008, 34: 154-163.PubMed
32.
Patel H, Bell D, Molokhia M, Srishanmuganathan J, Patel M, Car J, Majeed A: Trends in hospital admissions for adverse drug reactions in England: analysis of national episode statistics 1998-2005. BMC Clinical Pharmacology. 2007, 7: 9.CrossRefPubMedPubMedCentral
33.
Aktionsbündnis Patientensicherheit, Hrsg: Agenda Patientensicherheit 2007. 2007, Witten [Agenda Patient Safety 2007]
34.
van der Hooft CS, Sturkenboom MC, van Grootheest K, Kingma HJ, Stricker BH: Adverse drug reaction-related hospitalizations: a nationwide study in The Netherlands. Drug Safety. 2006, 29: 161-168. 10.2165/00002018-200629020-00006.CrossRefPubMed
35.
Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH: Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. NEJM. 1991, 324: 370-376. 10.1056/NEJM199102073240604.CrossRefPubMed
36.
Agenda Patientensicherheit 2008. Edited by: Schrappe M, Lessing C, Schmitz A, Conen D, Hart D, Hoppe-Tichy T, Jonitz G, Lauterberg J, Leppin G, Lichte T, Loskillet H. 2008, Witten [Agenda Patient Safety 2008]
37.
Classen DC, Pestotnik SL, Evans RS, Burke JP: Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991, 266: 2847-2851. 10.1001/jama.266.20.2847.CrossRefPubMed
38.
Feinstein AR: The pre-therapeutic classification of co-morbidity in chronic disease. J Chron Dis. 1970, 23: 455-468. 10.1016/0021-9681(70)90054-8.CrossRefPubMed
39.
Pompei P, Charlson ME, Ales K, MacKenzie CR, Norton M: Relating patient characteristics at the time of admission to outcomes of hospitalization. J Clin Epidemiol. 1991, 44: 1063-1069. 10.1016/0895-4356(91)90008-W.CrossRefPubMed
40.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M: Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009, 7: 357-363. 10.1370/afm.983.CrossRefPubMedPubMedCentral
41.
Edwards IR, Aronson JK: Adverse drug reactions: definitions, diagnoses, and management. Lancet. 2000, 356: 1255-1259. 10.1016/S0140-6736(00)02799-9.CrossRefPubMed
42.
Field TS, Gurwitz JH, Harrold LR, Rothschild JK, Debellis K, Seger AC, Fish LS, Garber L, Kelleher M, Bates DW: Strategies for detecting adverse drug events among older persons in the ambulatory setting. J Am Med Inform Assoc. 2004, 11: 492-498. 10.1197/jamia.M1586.CrossRefPubMedPubMedCentral
43.
Iezzoni LI: Assessing quality using administrative data. Annals of Internal Medicine. 1997, 127: 666-674.CrossRefPubMed
44.
Klaus B, Ritter A, Große Hülsewiesche H, Beyrle B, Euler HU, Fender H, Hübner M, von Mittelstaedt G: Study of the quality of codification of diagnoses and procedures under DRG conditions [in German]. Gesundheitswesen. 2005, 67: 9-19.CrossRefPubMed
45.
Stausberg J, Azaouagh A: Frequency of hospital-acquired pneumonia in electronic and paper-based patient record. eHealth: Beyond the Horizon - Get IT There - Proceedings of MIE2008 - The XXIst International Congress of the European Federation for Medical Informatics. Edited by: Andersen SK, Klein GO, Schulz S, Aarts J, Mazzolenie MC. 2008, Amsterdam: IOS Press, 470-483.
46.
Stausberg J, Kröger K, Maier I, Niebel W, Schneider S: Frequency of decubitus ulcer in patients of a university medical center. Combination of routine documentation and cross-sectional study [in German]. DMW. 2005, 130: 2311-2315. 10.1055/s-2005-918568.CrossRef
47.
Stausberg J: Quality of coding in acute inpatient care [in German]. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2007, 50: 1039-1046. 10.1007/s00103-007-0296-5.CrossRef
Metadata
Title
Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data
Authors
Jürgen Stausberg
Joerg Hasford
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-134

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