Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions
Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions
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DOI：
10.1097/pts.0000000000000517
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发表时间：
2020-06-01
影响因子：
2.2
通讯作者：
Pronovost, Peter J.
中科院分区：
文献类型：
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作者：
Padula, William, V;Black, Joyce M.;Pronovost, Peter J.
目的卫生系统正在努力提高卫生保健的质量和安全性。通过设定明确的期望，有机会配置护理模式，以降低不良事件的风险，提高护理质量。自2015年以来，美国医疗保险和医疗补助服务中心一直使用患者安全指标90（PSI 90），即医院获得性疾病（HAC）的综合比率，来调整付款并对医院进行质量评分。然而，PSI 90可能与用于防止某些状况超过其他状况的不利优先级相关联。我们的目标是评估2013年至2016年期间HAC的时间依赖性比率，以评估资助模式与不良事件（特别是压力性损伤）的关联。方法我们分析了在美国学术医疗中心住院的患者的回顾性观察队列，这些患者在PSI 90实施前后由Vizient CDB/RM观察。使用混合效应负二项回归模型纵向测量了2013年至2016年期间PSI 90的HAC组分率的变化。结果无论患者结局的复合指标是PSI 90还是所有HAC，总体而言，PSI 90实施后患者结局显著下降，反映了PSI 90与CMS报销政策之间的相关性。然而，在此时间范围内，压力损伤率增加了29.4%（SE = 0.08;P< 0.05），观察到的唯一HAC增加与PSI 90相关。结论：只有当医院充分激励医院对所有的HAC进行预防，而不是围绕预防工作失败所造成的伤害，医院的患者安全才会得到彻底改善。
Objective Health systems are grappling with improving the quality and safety of health care. By setting clear expectations, there is an opportunity to configure care models to decrease the risk of adverse events and promote the quality of care. The US Centers for Medicare and Medicaid Services have used Patient Safety Indicator 90 (PSI90), a composite rate of hospital-acquired conditions (HACs), to adjust payments and score hospitals on quality since 2015. However, PSI90 may be associated with adverse prioritization for preventing some conditions over others. Our objective was to evaluate the time-dependent rates of HACs between 2013 and 2016 to assess the association of funding models on adverse events, particularly pressure injury. Methods We analyzed a retrospective observational cohort of patients hospitalized in US Academic Medical Centers observed by the Vizient CDB/RM pre-post PSI90 implementation. Changes in HAC component rates of PSI90 between 2013 and 2016 were measured longitudinally using mixed-effects negative binomial regression modeling. Results Regardless of whether the composite measure of patient outcomes was PSI90 or all HACs, in general, there was significant decrease after PSI90 was implemented, reflecting an association between PSI90 and CMS reimbursement policy. However, pressure injury rates increased by 29.4% (SE = 0.08;P< 0.05) during this time frame, the only HAC observed to increase related to PSI90. Conclusions Patient safety in hospitals will only thoroughly improve when hospitals are fully incentivized to practice prevention of all HACs rather than work around the harms that result from failed prevention efforts.