医院获得性、导管相关尿路感染未予支付的影响：全州范围分析。
Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis.
机构信息
University of Michigan Medical School, Hospital Outcomes Program of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA.
出版信息
Ann Intern Med. 2012 Sep 4;157(5):305-12. doi: 10.7326/0003-4819-157-5-201209040-00003.
BACKGROUND
Most (59% to 86%) hospital-acquired urinary tract infections (UTIs) are catheter-associated urinary tract infections (CAUTIs). As of 2008, claims data are used to deny payment for certain hospital-acquired conditions, including CAUTIs, and publicly report hospital performance.
OBJECTIVE
To examine rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated events and evaluate how often nonpayment for CAUTI lowers hospital payment.
DESIGN
Before-and-after study of all-payer cross-sectional claims data.
SETTING
96 nonfederal acute care Michigan hospitals.
PATIENTS
Nonobstetric adults discharged in 2007 (n = 767 531) and 2009 (n = 781 343).
MEASUREMENTS
Hospital rates of UTIs (categorized as catheter-associated or hospital-acquired) and frequency of reduced payment for hospital-acquired CAUTIs.
RESULTS
Hospitals frequently requested payment for non-CAUTIs as secondary diagnoses: 10.0% (95% CI, 9.5% to 10.5%) of discharges in 2007 and 10.3% (CI, 9.8% to 10.9%) in 2009. Hospital rates of CAUTI were very low: 0.09% (CI, 0.06% to 0.12%) in 2007 and 0.14% (CI, 0.11% to 0.17%) in 2009. In 2009, 2.6% (CI, 1.6% to 3.6%) of hospital-acquired UTIs were described as CAUTIs. Nonpayment for hospital-acquired CAUTIs reduced payment for 25 of 781 343 (0.003%) hospitalizations in 2009.
LIMITATIONS
Data are from only 1 state and involved only 1 year before and after nonpayment for complications. Hospital prevention practices were not examined.
CONCLUSION
Catheter-associated UTI rates determined by claims data seem to be inaccurate and are much lower than expected from epidemiologic surveillance data. The financial impact of current nonpayment policy for hospital-acquired CAUTI is low. Claims data are currently not valid data sets for comparing hospital-acquired CAUTI rates for the purpose of public reporting or imposing financial incentives or penalties.
PRIMARY FUNDING SOURCE
Blue Cross Blue Shield of Michigan Foundation.
背景
大多数（59%至 86%）医院获得性尿路感染（UTI）是与导管相关的尿路感染（CAUTI）。截至 2008 年，索赔数据用于拒绝对某些医院获得性疾病（包括 CAUTI）进行支付，并公开报告医院的绩效。
目的
检查索赔数据中编码为医院获得性和导管相关性事件的成人 UTI 发生率，并评估不支付 CAUTI 费用对医院支付的影响。
设计
对所有支付者的横截面索赔数据进行前后研究。
设置
密歇根州 96 家非联邦急性护理医院。
患者
2007 年（n=767531）和 2009 年（n=781343）出院的非产科成年人。
测量
UTI 发生率（分类为导管相关性或医院获得性）和医院获得性 CAUTI 费用减少的频率。
结果
医院经常将非 CAUTI 请求作为次要诊断进行支付：2007 年为 10.0%（95%CI，9.5%至 10.5%），2009 年为 10.3%（CI，9.8%至 10.9%）。CAUTI 发生率非常低：2007 年为 0.09%（CI，0.06%至 0.12%），2009 年为 0.14%（CI，0.11%至 0.17%）。2009 年，2.6%（CI，1.6%至 3.6%）的医院获得性 UTI 被描述为 CAUTI。不支付医院获得性 CAUTI 导致 2009 年 781343 例住院患者中的 25 例（0.003%）的支付减少。
局限性
数据仅来自一个州，并且仅涉及支付并发症前一年和后一年。未检查医院预防措施。
结论
索赔数据确定的导管相关性 UTI 率似乎不准确，并且远低于流行病学监测数据。目前不支付医院获得性 CAUTI 的政策的财务影响较低。索赔数据目前不是用于比较医院获得性 CAUTI 率的有效数据集，无法用于公开报告或实施经济奖励或惩罚。
主要资金来源
蓝十字蓝盾密歇根基金会。
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