The Association Between the Risk Analysis Index of Frailty and Patient Safety Indicators: A Single-System Cohort...

Area of Science:

• Gerontology
• Health Services Research
• Patient Safety

Background:

• Frailty is linked to poor outcomes in hospitalized patients.
• The connection between frailty, patient safety indicators (PSIs), and healthcare costs is not well understood.
• This study investigates frailty's impact on PSIs and associated costs.

Purpose of the Study:

• To assess the association between the Risk Analysis Index (RAI) frailty measure and 13 surgical PSIs.
• To estimate the average cost of PSI events per at-risk encounter.
• To understand frailty's role in patient safety and hospital financial performance.

Main Methods:

• Retrospective cohort analysis of electronic health records from a multi-hospital system.
• Included adult inpatients with valid RAI scores at risk for adverse PSI events.
• Used logistic regression to analyze the association between frailty levels and PSI events, estimating costs.

Main Results:

• Frailty significantly increased odds of postoperative sepsis, acute kidney injury requiring dialysis, and respiratory failure.
• Higher patient frailty correlated with increased average costs per PSI event.
• Total estimated annual cost of PSI events across the system reached over $4 million.

Conclusions:

• Frailty is associated with higher rates and costs of PSIs, impacting hospital financial penalties.
• Current metrics in the Hospital-Acquired Condition Reduction Program may unfairly penalize hospitals with frail patient populations.
• Revising program metrics could prevent over-penalization and better reflect hospital care challenges.