title: Frequency of ambulatory care adverse events in Latin American countries: the AMBEAS/PAHO cohort study.
abstract: OBJECTIVE
  Determine the frequency and preventability of adverse events (AEs) from available information sources in selected ambulatory care (AC) sites in Latin America (LA).
  
  
  METHODS
  Multinational observational cohort was conducted to determine the period prevalence (retrospective focus) and the cumulative incidence (prospective focus) of AEs.
  
  
  METHODS
  Outpatient clinics in Mexico, Peru, Brazil and Colombia.
  
  
  METHODS
  A random selection of 2080 patients.
  
  
  METHODS
  The existence of AE was decided based on trigger information provided by the patient and crossing the data with each patient's medical history.
  
  
  METHODS
  AE occurrences 6 months prior (prevalence) and 42 days after (incidence) the patient receiving AC were identified. AE type and preventability were also described.
  
  
  RESULTS
  Two thousand eighty patients participated in the study. AEs prevalence was 5.2% (108/2080) [95% confidence interval (CI) 4.2-6.1%], and cumulative incidence was 2.4% (42/1757) (95% CI 1.7-3.1%). AEs considered preventable were 44% (55/108) of prevalence period, and 52.4% (22/42) of incidence period. Preventability was associated with patient socioeconomic status (OR 3.5, 95% CI 1.4-8.8), medication error (OR 0.1, 95% CI 0.0-0.4), diagnostic error (OR 0.1, 95% CI 0.0-0.8) and a minor impact on the patient (OR 0.2 95% CI 0.1-0.9).
  
  
  CONCLUSIONS
  The frequency of AE in ambulatory settings in LA is in the high-frequency range of research focused on the prevalence of AEs. Fifty percent was preventable. This study provides an approach for assessing the frequency and preventability of AE in order to enhance patient safety in LA.
authors.affiliation: Department of Quality Assurance, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Montserrat-Capella
authors.affiliation: Medical, Eye, and Dental International Care Organization (Medico), Austin, TX, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Suárez
authors.affiliation: Department of Statistics, Mathematics and Informatics, Universidad Miguel Hernández, Elche, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Ortiz
authors.affiliation: Alicante-Sant Joan Health District, Alicante, Spain Department of Health Psychology, Universidad Miguel Hernández, Elche, Spain.
authors.forename: José Joaquín
authors.initials: JJ
authors.lastname: Mira
authors.affiliation: Department of Obstetrics and Gynecological, Clinical Research Institute, Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Hernando Gaitán
authors.initials: HG
authors.lastname: Duarte
authors.affiliation: Department of Knowledge Management, Bioethics and Research, Pan American Health Organization, Washington, DC, USA.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Reveiz
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D008297:Male; D019300:Medical Errors / Q000145:classification / Q000517:prevention & control / Q000706:statistics & numerical data*; D064406:Patient Harm / Q000706:statistics & numerical data; D061214:Patient Safety; D015995:Prevalence; D011787:Quality of Health Care; D012959:Socioeconomic Factors
keywords: Latin America; adverse events; ambulatory care; patient safety; primary care