Brown Jack, Doloresco Iii Fred, Mylotte Joseph M
Department of Pharmacy, University of Rochester Medical Center, Rochester, New York, USA.
Clin Infect Dis. 2009 Sep 1;49(5):743-6. doi: 10.1086/604719.
Medicare stopped reimbursing United States hospitals for several complications or comorbidities developed during hospitalizations effective 1 October 2008. The Centers for Medicare and Medicaid Services selected high-cost or high-frequency events from the National Quality Forum's list of "never events" for inclusion in this reimbursement change. Several of these complications and/or comorbidities are nosocomial infections, a significant proportion of which are not likely to be preventable. Attempts to eliminate these events may have unwanted clinical and economic outcomes, and compliance with coding and billing requirements will have a significant effect on research conducted using administrative databases. Although this reimbursement change is a step toward reducing the rate of preventable adverse events, its current form does not provide guidance with regard to how hospitals may hope to reduce the rate of these infections, and it uses individual case-based rather than process-based or population-based outcome measures, which makes benchmarking and goalsetting difficult.
自2008年10月1日起，医疗保险不再为美国医院在住院期间出现的几种并发症或合并症报销费用。医疗保险和医疗补助服务中心从国家质量论坛的“绝不允许发生的事件”清单中挑选了高成本或高频事件，纳入此次报销政策的调整范围。其中几种并发症和/或合并症是医院感染，其中很大一部分不太可能被预防。试图消除这些事件可能会产生不良的临床和经济后果，并且遵守编码和计费要求将对使用行政数据库进行的研究产生重大影响。尽管此次报销政策的调整是朝着降低可预防不良事件发生率迈出的一步，但其目前的形式并未就医院如何希望降低这些感染的发生率提供指导，并且它使用的是基于个体病例而非基于过程或基于人群的结果指标，这使得基准比较和目标设定变得困难。
