Effect of Medicare's nonpayment for Hospital-Acquired Conditions: lessons for future policy.
Effect of Medicare's nonpayment for Hospital-Acquired Conditions: lessons for future policy.
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DOI：
10.1001/jamainternmed.2014.5486
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发表时间：
2015-03
影响因子：
39
通讯作者：
Shorr RI
中科院分区：
文献类型：
--
作者：
Waters TM;Daniels MJ;Bazzoli GJ;Perencevich E;Dunton N;Staggs VS;Potter C;Fareed N;Liu M;Shorr RI
2008年，医疗保险实施了医院获得性条件(HACs)倡议，这项政策拒绝为医院护理的8种并发症(也称为Never Events)提供增量付款。这一规定对这些事件的影响还没有得到很好的研究。为了衡量Medicare的拒付政策与HACS计划解决的4个结果之间的关联：中心线相关血流感染(CLABSI)、导管相关尿路感染(CAUTIs)、医院获得性压疮(HAPU)和损伤性住院患者跌倒。参与美国护士协会全国护理质量指标数据库(NDNQI)的1381家美国医院成人护理单位的准实验研究。NDNQI数据与美国医院协会、医疗保险成本报告和当地市场数据相结合，以检查调整后的结果。多水平模型被用来评估联邦医疗保险的不支付政策对Never事件的影响。从2008年10月开始，为医疗保险患者提供治疗的美国医院必须遵守新的付款政策。政策实施后，人身伤害、伤害性跌倒、CLABSI和CAUTIs的单位水平比率的变化。联邦医疗保险的不支付政策与CLABSI变化率(发病率比[IRR]，0.89；95%CI，0.83-0.95)和CAUTIs变化率(IRR，0.90；95%CI，0.85-0.95)降低11%有关，但与损伤性跌倒(IRR，0.99；95%CI，0.99-1.00)或腹痛(优势比，0.98；95%CI，0.96-1.01)的显著变化无关。考虑到单位、医院和市场层面的因素并没有显著改变我们的研究结果。HACs倡议与CLABSI和CAUTI趋势的改善有关，对于这些情况，有强有力的证据表明，更好的医院流程会产生更好的结果。然而，HACs倡议与HAPU或伤害跌倒趋势的改善无关，对于这些情况，更少的证据表明改变医院流程会带来显著更好的结果。
In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy on never events. United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95% CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95% CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95% CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95% CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings. The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.
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影响因子：
39.2
作者：
Meddings JA;Reichert H;Rogers MA;Saint S;Stephansky J;McMahon LF
通讯作者：
McMahon LF
影响因子：
1.4
作者：
McHugh, Megan;Martin, Timothy C.;Van Dyke, Kevin
通讯作者：
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影响因子：
2.2
作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
9.7
作者：
McNair, Peter D.;Luft, Harold S.;Bindman, Andrew B.
通讯作者：
Bindman, Andrew B.