Drug-Related Harms in Hospitalized Medicare Beneficiaries

Results From the Healthcare Cost and Utilization Project, 2000–2008

Abstract

Objectives 

We examined drug harms in Medicare beneficiaries using the 2000–2008 data from the Nationwide Inpatient Sample Healthcare Cost and Utilization Project.

Research Design 

This is a cross-sectional study to examine the national estimates of potentially preventable drug-related hospitalizations and in-hospital adverse drug events identified with the International Classification of Diseases codes excluding intentional harms.

Results 

Hospitalizations related to drug poisoning constituted 0.8% of all Medicare hospitalizations. Annual hospital charges increased from $1.6 billion in 2000 to $4 billion in 2008. In-hospital adverse drug events were noted in 5.3% of all Medicare hospitalizations and increased by 90% from 2000 to 2008. Patients with extreme versus minor loss of function (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.93–2.99) and with extreme versus minor likelihood of dying (OR, 2.30; 95% CI, 2.29–2.33) had increased odds of in-hospital adverse drug events after adjustment for age, sex, and race. The Medicare beneficiaries with more than 5 versus fewer than 5 listed diagnoses had greater odds of in-hospital adverse drug events (OR, 3.79; 95% CI, 3.76–3.82). Each additional diagnosis at discharge was associated with a 13% increase in odds of in-hospital death in the Medicare beneficiaries hospitalized with drug-related diagnoses and with 12% increase in odds of in-hospital death in the Medicare beneficiaries with in-hospital adverse events.

Conclusions 

Potentially preventable drug harms are a growing clinical and financial burden. Comparative outpatient drug safety should be analyzed using Medicare claim databases. In-hospital management of drug safety should target patients with multimorbidity and functional decline.