Evaluating the Effects of HACRP

项目摘要 医院获得性疾病（HAC）很常见、费用高昂且致命。尽管最近有所减少， 每1,000次放电发生121起事件。在以往的支付改革的基础上， 医疗保险和医疗补助服务中心启动了医院获得性疾病减少计划 （HACCP）。然而，在新的HACCP下，扩大对患者安全的激励措施的效果尚不清楚。 当前提案的目的是了解HACCP对患者和系统的影响 成功的医院在该计划下使用的具体战略和结果。我们的建议 目标1：评估医院获得性疾病的影响 患者结局的减少计划。我们将评估HACCP对两个目标的影响， 测量（例如患者安全指标）和下游结果（例如30天死亡率和再入院率）。 我们将检查有多少管理更改（例如，编码严重性的增加和 分母标准）解释HACCP的影响。我们假设HACCP会导致 但对下游结果的影响会减弱。我们还假设， 在该计划下，收入更高的医院面临风险， 目标2：评估改革的效果， 医院获得性疾病减少计划的支出。我们将评估HACCP的效果 30天总发作支出以及与指数住院，医生服务， 再入院、医院门诊护理和急性期后护理服务。我们假设HACCP会导致 减少总剧集支出以及剧集支出的下游组成部分;目标3： 评估医院获得性疾病减少计划下的改善因素 程序.我们将对参与密歇根价值的密歇根州医院进行案例研究分析 协作，密歇根州的蓝十字蓝盾和75家急性护理医院之间的伙伴关系， 密歇根州致力于提高质量和价值。我们假设从事系统性医疗的医院 质量改进工作将在有针对性的业绩衡量和 下游患者结局。我们的研究意义重大，因为我们的发现将用于为决策提供信息。 在CMS的制造商关于新的报销机制对质量，安全和支出的影响。我们 研究结果还将为医院和临床医生领导者提供有关如何改善HAC的可操作见解。 我们的研究是创新的，因为它使用独特的数据链接，提供者协作和多种方法， 评估关键政策改革的上游和下游影响。

Project Summary Hospital acquired conditions (HACs) are common, costly, and deadly. Despite recent reductions, HACs still occur at a rate of 121 events per 1,000 discharges. Building on previous payment reforms to reduce HACs, the Centers for Medicare and Medicaid Services initiated the Hospital Acquired Condition Reduction Program (HACRP). However, the effect of expanding incentives for patient safety under the new HACRP is unknown. The objective of the current proposal is to understand the impact of the HACRP on patient and system outcomes and the specific strategies used by successful hospitals to improve under the program. Our proposal will address the following three aims: Aim 1: Evaluate the effects of the Hospital Acquired Condition Reduction Program on patient outcomes. We will evaluate the effects of the HACRP on both targeted measures (e.g. patient safety indicators) and downstream outcomes (e.g. 30-day mortality and readmission). We will examine how much administrative changes (e.g. increases in coded severity and changes to denominator criteria) explain the impact of the HACRP. We hypothesize that the HACRP will lead to decreases in targeted measures but will have an attenuated effect on downstream outcomes. We also hypothesize that hospitals with more revenue at risk under the program and hospitals that are engaged in more value-based reforms will experience greater improvements in targeted outcomes; Aim 2: Evaluate the effects of the Hospital Acquired Condition Reduction Program on spending. We will evaluate the effects of the HACRP on 30-day total episode spending as well as spending related to the index hospitalization, physician services, readmissions, hospital outpatient care, and post-acute care services. We hypothesize that the HACRP will lead to decreases in total episode spending as well as the downstream components of episode spending; Aim 3: Evaluate the factors responsible for improvement under the Hospital Acquired Condition Reduction Program. We will perform a case study analysis of hospitals in Michigan that participate in the Michigan Value Collaborative, a partnership between BlueCross BlueShield of Michigan and 75 acute care hospitals in Michigan working to improve quality and value. We hypothesize that hospitals that are engaged in systematic quality improvement efforts will experience greater improvements on both targeted performance measures and downstream patient outcomes. Our study is significant because our findings will be used to inform decision makers at the CMS about the impact of new reimbursement mechanisms on quality, safety, and spending. Our findings will also provide hospitals and clinician leaders with actionable insights about how to improve HACs. Our study is innovative because it uses unique data linkages, provider collaboratives, and multiple methods to evaluate upstream and downstream effects of a key policy reform.