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Adverse events in spine surgery in Sweden: A comparison of patient claims data and national quality register (Swespine) data
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Spinal Surgery.
Östergötlands Läns Landsting, Patient Security. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
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2011 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 82, no 6, 727-731 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Our knowledge of complications and adverse events in spinal surgery is limited, especially concerning incidence and consequences. We therefore investigated adverse events in spine surgery in Sweden by comparing patient claims data from the County Councils' Mutual Insurance Company register with data from the National Swedish Spine Register (Swespine).

Methods: We analyzed patient claims (n = 182) to the insurance company after spine surgery performed between 2003 and 2005. The medical records of the patients filing these claims were reviewed and compared with Swespine data for the same period.

Results: Two-thirds (119/182, 65%) of patients who claimed economic compensation from the insurance company were registered in Swespine. Of the 210 complications associated with these 182 claims, only 74 were listed in Swespine. The most common causes of compensated injuries (n = 139) were dural lesions (n = 40) and wound infections (n = 30). Clinical outcome based on global assessment, leg pain, disability, and quality of health was worse for patients who claimed economic compensation than for the total group of Swespine patients.

Interpretation: We found considerable under-reporting of complications in Swespine. Dural lesions and infections were not well recorded, although they were important reasons for problems and contributed to high levels of disability. By analyzing data from more than one source, we obtained a better understanding of the patterns of adverse events and outcomes after spine surgery.

Place, publisher, year, edition, pages
Informa , 2011. Vol. 82, no 6, 727-731 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-72591DOI: 10.3109/17453674.2011.636673ISI: 000297352700016PubMedID: 22066564OAI: oai:DiVA.org:liu-72591DiVA: diva2:460193
Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Measures of Patient Safety: Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture
Open this publication in new window or tab >>Measures of Patient Safety: Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Unsafe health care delivery results in millions of patients suffering from injuries or death worldwide. A Swedish study estimated the prevalence of preventable adverse events as high as 8.6% in hospital care, which demonstrates that patient safety is no less a problem in Sweden than elsewhere. Reporting of adverse events has become an integral part of patient safety work. The aim of reporting is to identify patient safety problems and provide background data and information for efforts to improve patient safety. However, adverse events in health care can be captured and measured using different methods and stored in disparate systems that are not fully integrated. This makes it difficult to obtain a complete coherent picture of the frequency and nature of various types of adverse events. Another difficulty is to distinguish between adverse events and accepted complications of medical care.

The overall aim of this thesis is to generate knowledge for improved understanding of how patient safety can be measured in terms of reporting adverse events and improved by targeting patient safety culture with an intervention implemented in a Swedish county council. Three research questions have been derived from the aim: (1) To what extent can analysis of patient claims contribute to an understanding of the magnitude of the patient safety problem? (2) To what extent do data captured from different reporting systems in Sweden differ? (3) To what extent can a structured intervention that fosters learning on patient safety issues and encourages leadership commitment improve the patient safety culture in a Swedish county council from a five-year perspective?

The research is based on studies of three national reporting systems: Lex Maria to the National Board of Health and Welfare; patient claims to the County Councils´ Mutual Insurance Company; and medical data reported to the National Swedish Spine Register (Swespine). Data have also been assembled as part of an evaluation within the Patient Safety Dialogue intervention.

This thesis indicates that different Swedish reporting systems provide disparate views and have many discrepancies regarding data quality and coverage of adverse events. Patient claims seem to be an important source of information that can complement information from incident reporting systems and quality registries in health care to provide an understanding of the magnitude of the patient safety problem.

The research also shows that a structured intervention that fosters learning on patient safety issues and encourages leadership commitment can improve the culture of patient safety. However, a longer period of time and focused efforts might be required to achieve improvements across all departments within a Swedish county council.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 85 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1267
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72594 (URN)978-91-7393-043-7 (ISBN)
Public defence
2012-01-13, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2011-12-16Bibliographically approved

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Öhrn, AnnicaRutberg, HansNilsen, PerTropp, Hans

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Health Technology Assessment and Health EconomicsFaculty of Health SciencesPatient SafetyDepartment of Spinal SurgeryPatient SecuritySocial Medicine and Public Health ScienceOrthopaedics and Sports MedicineDepartment of Orthopaedics in Linköping
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