Making the CMS Payment Policy for Healthcare‐Associated Infections Work: Organizational Factors That Matter
Making the CMS Payment Policy for Healthcare‐Associated Infections Work: Organizational Factors That Matter
复制标题
使针对医疗保健相关感染的 CMS 支付政策发挥作用：重要的组织因素
DOI：
10.1097/00115514-201109000-00007
复制
发表时间：
2011
影响因子：
1.8
通讯作者：
Grace Lee
中科院分区：
文献类型：
--
作者：
T. Hoff;C. Hartmann;Christina Soerensen;M. Dutta;Grace Lee
医疗相关感染（HAI）是医院中最常见的不良事件之一，与之相关的发病率和死亡率很高。2008年，医疗保险和医疗补助服务中心（CMS）实施了一项新的财政政策，不再向医院支付与入院时不存在的某些感染相关的服务费用，并认为可以预防。目前，人们对这一政策在医院环境中的实施情况知之甚少。该政策的一个关键目标是使其成为医院内部质量改进的推动者，为医院参与更多与感染相关的监测和预防活动提供理由和动力。本文探讨的作用，组织因素，如领导和文化，发挥CMS政策的有效性作为一个质量改进（QI）的驱动程序在医院设置。2009年底至2010年初，对全国36家医院的36名感染预防专家进行了采访。我们发现初步证据表明，医院行政行为，积极主动的感染控制（IC）文化，和临床工作人员的参与，在提高认识，接受和CMS政策的重要性，作为一个QI驱动器在医院内发挥了有利的作用。我们还发现了其他几个可能阻碍上述因素促进CMS政策和医院QI活动之间联系的程度的背景因素。
EXECUTIVE SUMMARY Healthcare‐associated infections (HAIs) are among the most common adverse events in hospitals, and the morbidity and mortality associated with them are significant. In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a new financial policy that no longer provides payment to hospitals for services related to certain infections not present on admission and deemed preventable. At present, little is known about how this policy is being implemented in hospital settings. One key goal of the policy is for it to serve as a quality improvement driver within hospitals, providing the rationale and motivation for hospitals to engage in greater infection‐related surveillance and prevention activities. This article examines the role organizational factors, such as leadership and culture, play in the effectiveness of the CMS policy as a quality improvement (QI) driver within hospital settings. Between late 2009 and early 2010, interviews were conducted with 36 infection preventionists working at a national sample of 36 hospitals. We found preliminary evidence that hospital executive behavior, a proactive infection control (IC) culture, and clinical staff engagement played a favorable role in enhancing the recognition, acceptance, and significance of the CMS policy as a QI driver within hospitals. We also found several other contextual factors that may impede the degree to which the above factors facilitate links between the CMS policy and hospital QI activities.