Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.
Department of Statistics and Data Sciences, The University of Texas at Austin3Department of Integrative Biology, The University of Texas at Austin.
JAMA Intern Med. 2015 Mar;175(3):347-54. doi: 10.1001/jamainternmed.2014.5486.
In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied.
To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls.
DESIGN, SETTING, AND PARTICIPANTS: Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy on never events.
United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008.
Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy.
Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95% CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95% CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95% CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95% CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings.
The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.
2008 年，医疗保险实施了医院获得性条件（HACs）倡议，该政策拒绝为医院护理的 8 种并发症（也称为永不发生的事件）提供额外支付。该法规对这些事件的影响尚未得到很好的研究。
测量医疗保险非支付政策与 HACs 倡议所针对的 4 种结果之间的关联：中心静脉置管相关血流感染（CLABSIs）、导尿管相关尿路感染（CAUTIs）、医院获得性压疮（HAPUs）和住院伤害性跌倒。
设计、地点和参与者：对来自美国 1381 家参与美国护士协会国家护理质量指标数据库（NDNQI）的成人护理单元进行准实验研究。NDNQI 数据与美国医院协会、医疗保险成本报告和当地市场数据相结合，以检查调整后的结果。使用多层次模型评估医疗保险非支付政策对永不发生的事件的影响。
为医疗保险患者提供治疗的美国医院自 2008 年 10 月开始实施新的支付政策。
政策实施后单位水平 HAPUs、伤害性跌倒、CLABSIs 和 CAUTIs 发生率的变化。
医疗保险的非支付政策与 CLABSIs 发生率变化率降低 11%（发病率比 [IRR]，0.89；95%CI，0.83-0.95）和 CAUTIs 发生率变化率降低 10%（IRR，0.90；95%CI，0.85-0.95）相关，但与伤害性跌倒（IRR，0.99；95%CI，0.99-1.00）或 HAPUs（比值比，0.98；95%CI，0.96-1.01）发生率的显著变化无关。考虑到单位、医院和市场水平的因素并没有显著改变我们的发现。
HACs 倡议与 CLABSI 和 CAUTI 趋势的改善相关，有强有力的证据表明，改善医院流程会带来更好的结果。然而，HACs 倡议与 HAPU 或伤害性跌倒趋势的改善无关，对于这些条件，改变医院流程是否会带来显著更好的结果证据较少。
