Effect of Nonpayment for Preventable Infections in US Hospitals
Effect of Nonpayment for Preventable Infections in US Hospitals
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DOI：
10.1056/nejmsa1202419
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发表时间：
2012-10-11
影响因子：
158.5
通讯作者：
Jha, Ashish K.
中科院分区：
文献类型：
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作者：
Lee, Grace M.;Kleinman, Ken;Jha, Ashish K.
背景2008年10月，医疗保险和医疗补助服务中心(CMS)停止了对某些被认为是可以预防的医院获得的疾病的额外支付。这一政策对卫生保健相关感染发生率的影响尚不清楚。方法采用中断时间序列和比较序列的准实验设计，我们检验了CMS政策针对的两种卫生保健相关感染(中心导管相关血流感染和导管相关尿路感染)与政策未针对的结果(呼吸机相关肺炎)的趋势变化。参加国家医疗安全网络的医院，并在政策生效前报告至少一种与医疗相关的感染数据，都有资格参加。数据包括2006年1月至2011年3月。我们使用回归模型来衡量政策对感染率变化的影响，并根据基线趋势进行调整。结果根据感染类型，总共有398家医院或卫生系统贡献了14,817至28,339个医院单位月。早在政策实施之前，我们就观察到靶向感染和非靶向感染的长期趋势都在下降。政策实施后，中心静脉导管相关血流感染(实施后与实施前的发病率比为1.00；P=0.97)、导管相关性尿路感染(发病率比为1.03；P=0.08)、呼吸机相关肺炎(发病率比为0.99；P=0.52)的季度发病率均无显著变化。我们的结果在没有强制报告的州的医院中没有不同，也没有根据医疗保险入院百分比或医院规模、所有权类型或教学状况的四分之一而不同。结论我们没有发现证据表明2008年CMS政策减少中心导管相关性血流感染和导管相关性尿路感染的费用对美国医院的感染率有任何可衡量的影响。(由医疗研究和质量机构提供资金。)
BackgroundIn October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued additional payments for certain hospital-acquired conditions that were deemed preventable. The effect of this policy on rates of health care-associated infections is unknown.MethodsUsing a quasi-experimental design with interrupted time series with comparison series, we examined changes in trends of two health care-associated infections that were targeted by the CMS policy (central catheter-associated bloodstream infections and catheter-associated urinary tract infections) as compared with an outcome that was not targeted by the policy (ventilator-associated pneumonia). Hospitals participating in the National Healthcare Safety Network and reporting data on at least one health care-associated infection before the onset of the policy were eligible to participate. Data from January 2006 through March 2011 were included. We used regression models to measure the effect of the policy on changes in infection rates, adjusting for base-line trends.ResultsA total of 398 hospitals or health systems contributed 14,817 to 28,339 hospital unit-months, depending on the type of infection. We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented. There were no significant changes in quarterly rates of central catheter-associated bloodstream infections (incidence-rate ratio in the postimplementation vs. preimplementation period, 1.00; P = 0.97), catheter-associated urinary tract infections (incidence-rate ratio, 1.03; P = 0.08), or ventilator-associated pneumonia (incidence-rate ratio, 0.99; P = 0.52) after the policy implementation. Our findings did not differ for hospitals in states without mandatory reporting, nor did it differ according to the quartile of percentage of Medicare admissions or hospital size, type of ownership, or teaching status.ConclusionsWe found no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals. (Funded by the Agency for Healthcare Research and Quality.)