Patient Safety & Quality | Links Medicus Content Curation & Alerts in Medicine

Retrospective Analysis: 7% of outpatients in Massachusetts experience adverse events, predominantly drug-related – Ann Intern Med

25 May, 2024 | 19:37h | UTC

This retrospective study reviewed electronic health records from 11 outpatient sites in Massachusetts during 2018 to assess the incidence and nature of adverse events (AEs) in 3,103 patients. AEs were identified in 7.0% of the patients, translating to 8.6 events per 100 patients annually. Adverse drug events were the most frequent type of AE, constituting 63.8% of events, followed by healthcare-associated infections (14.8%) and surgical or procedural events (14.2%). The severity of these events was notable, with 17.4% being serious and 2.1% life-threatening, though none were fatal. Notably, 23.2% of these events were deemed preventable. The risk of experiencing at least one AE varied significantly by age and race, with higher rates observed among older adults and Black patients compared to other demographics. The study highlights the pressing need for targeted interventions to reduce AEs in outpatient settings.

Reference (link to abstract – $ for full-text):

David M. Levine et al. (2023). The Safety of Outpatient Health Care: Review of Electronic Health Records. Annals of Internal Medicine, [insert volume and issue], [insert pages]. DOI: 10.7326/M23-2063

Cluster-Randomized Trial: No reduction in hospitalization rates with EHR-based algorithm in chronic kidney disease patients

30 Apr, 2024 | 13:16h | UTC

This study evaluates the effectiveness of a personalized EHR-based algorithm combined with practice facilitators to reduce hospitalization rates among patients with chronic kidney disease, type 2 diabetes, and hypertension. Conducted as an open-label, cluster-randomized trial across 141 primary care clinics, 11,182 patients were divided into two groups: the intervention group (5,690 patients) and the usual-care group (5,492 patients). After one year, the hospitalization rate was slightly lower in the intervention group (20.7%) compared to the usual-care group (21.1%), but this difference was not statistically significant (p=0.58). Secondary outcomes, including emergency department visits, readmissions, cardiovascular events, dialysis, and death rates were similar between the groups, except for a slightly higher rate of acute kidney injury in the intervention group. The study concludes that the EHR-based intervention did not significantly decrease hospitalizations at one year.

Commentary on X:

Original Article: Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease (ICD-Pieces trial) https://t.co/aJ0Ao0uf90 #Nephrology pic.twitter.com/l4xc54Buxy

— NEJM (@NEJM) April 8, 2024

Reference (link to abstract – $ for full-text):

Miguel A. Vazquez et al. (2024). Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease. N Engl J Med, 390(13), 1196-1206. DOI: 10.1056/NEJMoa2311708

Meta-Analysis: Effectiveness of therapist-guided remote vs. in-person cognitive behavioral therapy

20 Mar, 2024 | 19:32h | UTC

Study Design and Population: This systematic review and meta-analysis investigated the efficacy of therapist-guided remote cognitive behavioral therapy (CBT) compared to traditional in-person CBT. The authors conducted a comprehensive search across several databases, including MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials, up to July 4, 2023. A total of 54 randomized controlled trials (RCTs) were included, encompassing 5463 adult patients presenting with various clinical conditions. The study meticulously assessed the risk of bias and extracted data using a standardized approach, and outcomes were analyzed using a random-effects model.

Main Findings: The primary analysis focused on patient-important outcomes, comparing the effectiveness of remote and in-person CBT across diverse conditions such as anxiety and related disorders, depressive symptoms, insomnia, chronic pain or fatigue syndromes, body image or eating disorders, tinnitus, alcohol use disorder, and mood and anxiety disorders. The meta-analysis, based on moderate-certainty evidence, found little to no difference in effectiveness between remote and in-person CBT (standardized mean difference [SMD] −0.02, 95% confidence interval −0.12 to 0.07), suggesting that both delivery methods are comparably effective across a range of disorders.

Implications for Practice: The findings indicate that therapist-guided remote CBT is nearly as effective as in-person CBT for treating a variety of mental health and somatic disorders. This supports the potential for remote CBT to significantly increase access to evidence-based care, especially in settings where in-person therapy is not feasible or is limited by geographic, economic, or social barriers. Future research should explore optimizing remote CBT delivery methods to further enhance accessibility and efficacy.

Reference: Zandieh, S. et al (2024). Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ, 196(10), E327-E340. [Link]

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