Evaluating the Effects of HACRP

项目摘要 医院获得性疾病(HAC)是常见的、昂贵的和致命的。尽管最近有所减少，但HAC仍然 以每1,000次放电121次的速度发生。在之前为减少HAC而进行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的条件减少计划 (HACRP)。然而，在新的HACRP下，扩大激励措施对患者安全的影响尚不清楚。 目前建议的目的是了解HACRP对患者和系统的影响 结果和成功的医院在该计划下改善所使用的具体策略。我们的建议 将解决以下三个目标：目标1：评估医院获得性条件的影响 减少计划对患者结果的影响。我们将评估HACRP对这两个目标的影响 衡量标准(如患者安全指标)和下游结果(如30天死亡率和再入院情况)。 我们将检查有多少管理更改(例如，增加编码的严重性和更改 分母标准)解释了HACRP的影响。我们假设HACRP将导致下降 在有针对性的措施中，但对下游结果的影响将减弱。我们还假设 在该计划下具有更多风险收入的医院以及从事更多基于价值的医院 改革将在目标结果方面有更大的改进；目标2：评估改革的效果 医院在支出上获得了条件减少计划。我们将评估HACRP的效果 关于30天的总住院费用以及与住院、医生服务、 重新入院、医院门诊护理和急诊后护理服务。我们假设HACRP将领导 减少剧集总支出以及剧集支出的下游部分；目标3： 评估医院获得性条件减少下的改善因素 程序。我们将对密歇根州参与密歇根价值观的医院进行案例分析 Collaborative，密歇根州BlueCross BlueShield和75家急性护理医院在 密歇根州致力于提高质量和价值。我们假设从事系统性研究的医院 质量改进工作将在有针对性的绩效衡量和 下游患者结局。我们的研究意义重大，因为我们的研究结果将被用于决策 新的报销机制对质量、安全和支出的影响。我们的 研究结果还将为医院和临床医生领导提供关于如何改善HAC的可行见解。 我们的研究具有创新性，因为它使用独特的数据链接、提供商协作和多种方法来 评估一项关键政策改革的上下游影响。

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.