California hospitals response to state and federal policies related to health care-associated infections.
California hospitals response to state and federal policies related to health care-associated infections.
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DOI：
10.1177/1527154411416129
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发表时间：
2011-05
期刊：
影响因子：
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通讯作者：
Larson EL
中科院分区：
文献类型：
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作者：
Stone PW;Pogorzelska M;Graham D;Jia H;Uchida M;Larson EL
2008年10月，医疗保险和医疗补助服务中心（CMS）拒绝支付10个选定的医疗保健相关感染（HAI）。2009年1月，加州颁布了强制性报告感染预防过程和HAI率的规定。这项纵向混合方法研究探讨了联邦和州政策变化对加州医院的影响。在政策变化前后收集了有关护理结构、过程和结果的数据。政策实施后，对医院工作人员进行了深入访谈。200多家医院参加了调查，25名工作人员接受了访谈。我们发现采用和坚持循证实践的人数显著增加，HAI率下降（p <0.05）。感染预防人员（IP）花在监测和办公室的时间更多，花在教育和其他地点的时间更少（p < .05）。定性数据证实，强制性报告具有预期和非预期的后果，并强调了技术和组织环境在预防感染方面的重要性以及综合方案不断变化的作用。这一点尤其重要，因为加州公共卫生部已要求医院报告29种不同手术部位感染的数据，并已提起诉讼，以推迟实施这些要求。
In October 2008, the Centers for Medicare and Medicaid Services (CMS) denied payment for ten selected health care–associated infections (HAI). In January 2009, California enacted mandatory reporting of infection prevention processes and HAI rates. This longitudinal mixed-methods study examined the impact of federal and state policy changes on California hospitals. Data on structures, processes, and outcomes of care were collected pre- and post-policy changes. In-depth interviews with hospital personnel were performed after policy implementation. More than 200 hospitals participated with 25 personnel interviewed. We found significant increases in adoption of and adherence to evidence-based practices and decreased HAI rates (p < .05). Infection preventionists (IP) spent more time on surveillance and in their offices and less time on education and in other locations (p < .05). Qualitative data confirmed mandatory reporting had intended and unintended consequences and highlighted the importance of technology and organizational climate in preventing infections and the changing IPs’ role. This is especially relevant because the California Department of Public Health has since mandated hospitals to report data on 29 different for surgical site infections and a lawsuit has been filed to delay the implementation of these requirements.