Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis.
Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis.
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DOI：
10.7326/0003-4819-157-5-201209040-00003
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发表时间：
2012-09-04
影响因子：
39.2
通讯作者：
McMahon LF
中科院分区：
文献类型：
--
作者：
Meddings JA;Reichert H;Rogers MA;Saint S;Stephansky J;McMahon LF
大多数医院获得性尿路感染（uti）（59%至86%）是导尿管相关性尿路感染（CAUTI）。截至2008年，索赔数据被用于拒绝支付医院获得性疾病（如CAUTI）的费用，并公开报告医院的业绩。检查在索赔数据中编码为医院获得性和导管相关的成人尿路感染的发生率，并评估不支付CAUTI费用降低医院费用的频率。2007年（N=757531）和2009年（N=781343）密歇根州非联邦急症护理医院出院的非产科成人尿路感染（分类为导管相关和/或医院获得性）的住院率，以及医院获得性尿路感染的减少支付频率的前后研究。医院经常要求支付非导管相关尿路感染作为次要诊断：2007年10.0%的出院（95%置信区间：9.5至10.5），2009年10.3%（置信区间：9.8至10.9）。CAUTI住院率非常低：2007年为0.09% (CI: 0.06 ~ 0.12)；0.14% （CI: 0.11至0.17）。2009年，2.6% （CI: 1.6 - 3.6）的医院获得性尿路感染被描述为导管相关。2009年，781343例住院患者中有25例（0.003%）因医院获得性CAUTIs未付款而减少了付款。数据仅来自一个州，仅涉及未支付并发症前后一年的情况。没有审查医院的预防措施。由索赔数据确定的CAUTI率似乎不准确，远低于流行病学监测数据的预期。目前不付款政策对医院获得的CAUTI的财务影响很小。索赔数据目前不是一个有效的数据集，用于比较医院获得的CAUTI比率，用于公开报告或实施财政激励或处罚。
The majority (59 to 86%) of hospital-acquired urinary tract infections (UTIs) are catheter-associated urinary tract infections (CAUTI). As of 2008, claims data are used to deny payment for hospital-acquired conditions such as CAUTI and to publicly report hospital performance. To examine rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated and evaluate how often non-payment for CAUTI lowers hospital payment. Before-and-after study of all-payer cross-sectional claims data 96 nonfederal acute-care Michigan hospitals Non-obstetric adults discharged in 2007 (N=757531) and 2009 (N=781343) Hospital rates of UTIs (categorized as catheter-associated and/or hospital-acquired), and frequency of reduced payment for hospital-acquired CAUTIs. Hospitals frequently requested payment for non-catheter-associated UTIs as secondary diagnoses: 10.0% of discharges (95% CI: 9.5 to 10.5) in 2007, 10.3% (CI: 9.8 to 10.9) in 2009. Hospital rates of CAUTI were very low: 0.09% (CI: 0.06 to 0.12) in 2007; 0.14% (CI: 0.11 to 0.17) in 2009. In 2009, 2.6% (CI: 1.6 to 3.6) of hospital-acquired UTIs were described as catheter-associated. Non-payment for hospital-acquired CAUTIs lowered payment for 25 of 781343 (0.003%) hospitalizations in 2009. Data are from only one state and involved only one year before-and-after non-payment for complications. Hospital prevention practices were not examined. CAUTI rates determined by claims data appear inaccurate and are much lower than expected from epidemiologic surveillance data. The financial impact of current non-payment policy for hospital-acquired CAUTI is low. Claims data is currently not a valid dataset for comparing hospital-acquired CAUTI rates for the purpose of public reporting or imposing financial incentives or penalties.
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DOI：
10.1177/1527154411416129
发表时间：
2011-05
期刊：
Policy, politics & nursing practice
影响因子：
--
作者：
Stone PW;Pogorzelska M;Graham D;Jia H;Uchida M;Larson EL
通讯作者：
Larson EL
影响因子：
11.8
作者：
Maki DG;Tambyah PA
通讯作者：
Tambyah PA
影响因子：
1.4
作者：
McHugh, Megan;Martin, Timothy C.;Van Dyke, Kevin
通讯作者：
Van Dyke, Kevin
影响因子：
9.7
作者：
McNair, Peter D.;Luft, Harold S.;Bindman, Andrew B.
通讯作者：
Bindman, Andrew B.
影响因子：
4.5
作者：
Meddings, Jennifer;Saint, Sanjay;McMahon, Laurence F., Jr.
通讯作者：
McMahon, Laurence F., Jr.