CMS changes in reimbursement for HAIs: setting a research agenda.
CMS changes in reimbursement for HAIs: setting a research agenda.
复制标题
DOI：
10.1097/mlr.0b013e3181d5fb3f
复制
发表时间：
2010-05
期刊：
影响因子：
3
通讯作者：
Larson EL
中科院分区：
文献类型：
--
作者：
Stone PW;Glied SA;McNair PD;Matthes N;Cohen B;Landers TF;Larson EL
医疗保险和医疗补助服务中心（CMS）颁布了从2008年10月1日开始的规定，拒绝支付住院期间发生的选定条件，并在入院时不存在。新CMS政策涵盖的10种医院获得性疾病中有3种涉及医疗保健相关感染，这是住院患者发病率和死亡率的常见、昂贵且通常可以预防的原因。概述CMS支付政策对医疗系统和预防医疗相关感染的影响的研究议程。2009年4月举行了一次为期一天的邀请会议。包括规划委员会和发言人在内，有41名与会者是国家专家和高级研究人员。建立在行为模式和组织理论和管理研究的概念框架，适用于组织出现的广泛的问题。确定了一系列广泛的研究课题。32个研究议程项目组织在激励措施，环境因素，组织因素，临床结果，工作人员的成果和财务成果的领域。还讨论了方法上的挑战。这项政策是将基于产出的住院资金转移到基于结果的资金的第一个重要步骤，这一议程适用于所有医院获得性疾病。很快开始的研究最有希望获得政策变化前几年的数据，这是非实验研究的关键因素。CMS支付政策提供了一个很好的机会来了解和影响使用财务激励措施来改善患者安全。
The Centers for Medicare and Medicaid Services (CMS) promulgated regulations commencing October 1, 2008, which deny payment for selected conditions occurring during the hospital stay and are not present on admission. Three of the 10 hospital-acquired conditions covered by the new CMS policy involve healthcare-associated infections, which are a common, expensive, and often preventable cause of inpatient morbidity and mortality. To outline a research agenda on the impact of CMS’s payment policy on the healthcare system and the prevention of healthcare-associated infections. An invitational daylong conference was convened in April 2009. Including the planning committee and speakers there were 41 conference participants who were national experts and senior researchers. Building upon a behavioral model and organizational theory and management research a conceptual framework was applied to organize the wide range of issues that arose. A broad array of research topics was identified. Thirty-two research agenda items were organized in the areas of incentives, environmental factors, organizational factors, clinical outcomes, staff outcomes, and financial outcomes. Methodological challenges are also discussed. This policy is a first significant step to move output-based inpatient funding to outcome-based funding, and this agenda is applicable to all hospital-acquired conditions. Studies beginning soon will have the best hope of capturing data for the years preceding the policy change, a key element in nonexperimental research. The CMS payment policy offers an excellent opportunity to understand and influence the use of financial incentives for improving patient safety.