CMS Nonpayment for Nosocomial Injury and Risk of Falls in Hospitals

描述（由申请人提供）：意外跌倒是住院期间最常见的不良事件之一。大约30%会造成伤害，其中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）不再报销医院在住院期间因跌倒而受伤的治疗费用。1-4尽管这一规则变更的目的是同时降低住院患者的成本并提高医疗保健质量，但尚不清楚这一报销变化将对医院的跌倒和预防跌倒战略产生什么影响。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。总伤员摔倒。本研究的第二个目的是确定CMS不支付医院伤害是否会导致以下方面的变化：使用身体约束。围绕在医院环境中使用身体约束存在相当大的争议身体约束的不利影响已被很好地描述；然而，目前尚不清楚在急性护理环境中使用物理约束是否可以防止跌倒。本研究的第三个目的是确定：3。使用肢体约束与患者跌倒风险的关系为：3a级。护理单元和3b。病人，4。在护理单位层面上，使用肢体约束与跌倒之间的关系是否会因CMS支付方式的改变而改变。这些目标将通过两种方法来实现：1)单位水平的目标将通过54个月的准实验研究和在CMS支付方式改变前27个月至27个月的身体约束来解决；2)患者水平的假设将通过匹配的病例对照方法来检验。将使用两个数据来源。单位层面的目标将使用来自国家护理质量指标数据库（NDNQI）的数据来解决。与该应用程序相关的是，从全国各地近1000家急症护理医院系统地收集了关于跌倒、伤害性跌倒、身体约束使用以及人员配置信息的数据。患者层面的目标将使用来自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完成。这些医院共享一个统一的电子医疗记录系统，这将使我们能够应用我们为美国国立卫生研究院资助的近距离警报监测试验开发的许多数据收集方法，以防止在MHUH进行跌倒。除了为今后关于患者安全的立法提供信息外，这项研究的信息还将有助于支持制定有效的组织和针对患者的战略以减少医院跌倒的长期目标。公共卫生相关性：本研究的主要目的是确定取消医疗保险对医院持续受伤的支付是否与跌倒频率的变化和预防跌倒策略的变化有关，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.