Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000-2013.
Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000-2013.
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DOI：
10.1097/pts.0000000000000615
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发表时间：
2021-06-01
影响因子：
2.2
通讯作者：
Hernandez-Boussard T
中科院分区：
文献类型：
--
作者：
Tedesco D;Moghavem N;Weng Y;Fantini MP;Hernandez-Boussard T
提高质量和安全是全球优先事项。在过去的二十年里，美国已经推出了几项支付改革，以提高病人的安全。医疗保健研究和质量机构（AHRQ）开发了使用管理数据和患者安全指标（PSI）识别可预防的住院不良事件的工具。这项研究的目的是评估与美国按绩效付费改革相对应的国家患者安全趋势的变化。这是一个回顾性的，纵向分析，以估计时间的变化，在13个AHRQ的PSI。来自AHRQ的全国住院患者样本和估计值被加权以代表全国样本。我们分析了PSI趋势，医疗补助和医疗保险服务中心支付政策的变化，以及2000年至2013年期间的住院患者前瞻性支付系统法规和通知。在研究的13个PSI中，10个的比率总体下降，3个上升。Joinpoint分析显示，13个PSI中有12个在研究的最后5年中呈下降或稳定趋势。中心静脉导管血流感染的年下降率最高（2006年至2013年的年变化率为-31.1%），而术后呼吸衰竭的年下降率最低（2005年至2013年的年变化率为-3.5%）。除了术后髋骨骨折，在联邦支付改革举措之前，趋势显著下降。从2000年到2015年，全国住院患者的安全性得到了显著改善，这是通过PSI来衡量的。在这项研究中，PSI趋势的改善往往是针对患者安全事件的政策，这表明，针对患者安全的激烈的公共话语可能会推动国家政策改革，这些改善的趋势可能会持续医疗保险和医疗补助服务中心的政策。
Quality and safety improvement are global priorities. In the last two decades, the United States has introduced several payment reforms to improve patient safety. The Agency for Healthcare Research and Quality (AHRQ) developed tools to identify preventable inpatient adverse events using administrative data, patient safety indicators (PSIs). The aim of this study was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. This is a retrospective, longitudinal analysis to estimate temporal changes in 13 AHRQ’s PSIs. National inpatient sample from the AHRQ and estimates were weighted to represent a national sample. We analyzed PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013. Of the 13 PSIs studied, 10 had an overall decrease in rates and 3 had an increase. Joinpoint analysis showed that 12 of 13 PSIs had decreasing or stable trends in the last 5 years of the study. Central-line blood stream infections had the greatest annual decrease (−31.1 annual percent change between 2006 and 2013), whereas postoperative respiratory failure had the smallest decrease (−3.5 annual percent change between 2005 and 2013). With the exception of postoperative hip fracture, significant decreases in trends preceded federal payment reform initiatives. National in-hospital patient safety has significantly improved between 2000 and 2015, as measured by PSIs. In this study, improvements in PSI trends often proceeded policies targeting patient safety events, suggesting that intense public discourses targeting patient safety may drive national policy reforms and that these improved trends may be sustained by the Center for Medicare and Medicaid Services policies that followed.