CMS Nonpayment for Nosocomial Injury and Risk of Falls in Hospitals

描述（由申请方提供）：意外福尔斯是住院期间最常见的不良事件。大约30%的人会受伤，其中大约三分之一会造成严重伤害。从2008年10月1日开始，医疗保险和医疗补助服务中心（CMS）不再报销医院对住院期间发生的福尔斯受伤的治疗费用。1 -4尽管这一规则变化的目的是同时降低住院患者的成本和提高医疗保健质量，目前还不清楚这种报销变化对医院中的福尔斯和跌倒预防策略有什么影响。本研究的主要目的是确定这种“立法干预”是否与以下方面的变化有关：1。全伤患者福尔斯摔倒。本研究的第二个目的是确定CMS对医院伤害的不支付是否会导致以下方面的变化：2。使用身体限制。围绕在医院环境中使用身体约束存在相当大的争议。7，11，12身体约束的不良影响已得到很好的描述;然而，尚不清楚使用身体约束是否可以防止急性护理环境中的福尔斯跌倒。本研究的第三个目的是确定：3。身体约束使用与患者福尔斯风险之间的关系处于：3a.护理单元，和3b.病人，4。身体约束使用和福尔斯之间的关系是否改变CMS支付的护理单位的水平变化。这些目标将使用两种方法实现：1）将使用54个月的准实验研究和CMS支付变化后27个月前27个月至27个月的身体约束使用来解决单位层面的目标，以及2）将使用匹配的病例对照方法来测试患者层面的假设。将使用两个数据源。将使用国家护理质量指标数据库（NDNQI）的数据来解决单位级目标。与此应用相关的是，在护理单位一级系统地从全国各地区近1000家急诊医院收集了有关福尔斯、伤害性福尔斯、身体约束使用以及人员配备信息的数据。患者水平的目标将使用卫理公会医疗保健系统（MHC）四家成人医院的24个成人医疗和/或外科护理单位的数据来实现。这些医院共享一个统一的电子病历系统，这将使我们能够应用许多方法来收集数据，我们开发了一个NIH资助的试验接近报警监测，以防止福尔斯在MHUH进行。除了为未来的患者安全立法提供信息外，本研究的信息还将有助于实现长期目标，支持制定有效的组织和患者特定策略，以减少医院中的福尔斯。公共卫生相关性：本研究的主要目的是确定是否取消医疗保险支付的伤害持续在医院与变化的频率福尔斯和跌倒预防策略的变化，特别是使用物理约束。

DESCRIPTION (provided by applicant): Accidental falls are among the most common reported adverse events which occur during hospitalization. About 30% result in injury and of these, about a third cause serious injury. Beginning October 1, 2008, the Centers for Medicare & Medicaid Services (CMS) no longer reimbursed hospitals for treatment of injuries resulting from falls which occur during hospitalization.1-4 Although the intent of this rule change is to simultaneously reduce cost and improve the quality of health care in hospitalized patients, it is unknown what the effect of this reimbursement change will have on falls and fall prevention strategies in hospitals. The primary aim of this study is to determine whether this "legislative intervention" is associated with changes in: 1. Total and injurious patient falls. The secondary aim of this study is to determine whether CMS nonpayment for nosocomial injury results in changes in: 2. Use of physical restraints. There is considerable controversy surrounding the use of physical restraints in hospital settings.7,11,12 The adverse effects of physical restraints have been well described; however, it is not clear whether use of physical restraints prevents falls in acute care settings. The tertiary aims of this study are to determine: 3. The relationship between physical restraint use and the risk of patient falls at the level of the: 3a. nursing unit, and 3b. patient, and 4. Whether the relationship between physical restraint use and falls is altered by CMS payment changes at the level of the nursing unit. These aims will be accomplished using two approaches: 1) unit level aims will be addressed using a 54 month quasi-experimental study and physical restraint use 27 months before through 27 months after the CMS payment changes, and 2) patient-level hypotheses will be tested using a matched case-control approach. Two data sources will be utilized. Unit-level aims will be addressed using data from the National Database of Nursing Quality Indicators (NDNQI). Relevant to this application, data on falls, injurious falls, physical restraint use, as well as staffing information have been collected at the level of nursing unit in a systematic manner from nearly 1000 acute-care hospitals from every region of the country. Patient-level aims will be accomplished using data from 24 adult medical and/or surgical nursing units at the four adult hospitals in the Methodist Healthcare System (MHC). These hospitals share a unified electronic medical record system which will allow us to apply many of the approaches to data collection we developed for an NIH-funded trial of proximity alarm monitoring to prevent falls conducted at MHUH. In addition to informing future legislation on patient safety, information from this study will contribute to the long-term goals supporting the development of effective organizational and patient-specific strategies to reduce falls in hospitals. PUBLIC HEALTH RELEVANCE: The primary aim of this study is to determine whether elimination of Medicare payment for injuries sustained in hospitals is associated with changes in the frequency of falls and changes in fall prevention strategies, particularly the use of physical restraints.