Padula William V, Makic Mary Beth F, Wald Heidi L, Campbell Jonathan D, Nair Kavita V, Mishra Manish K, Valuck Robert J
Section of Hospital Medicine, University of Chicago, USA.
Jt Comm J Qual Patient Saf. 2015 Jun;41(6):257-63. doi: 10.1016/s1553-7250(15)41035-9.
In 2007, the Centers for Medicare & Medicaid Services (CMS) announced its intention to no longer reimburse hospitals for costs associated with hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired conditions (HACs), which was followed by enactment of the nonpayment policy in October 2008. This study was conducted to define changes in HAPU incidence and variance since 2008.
In a retrospective observational study, HAPU cases were identified at 210 University HealthSystem Consortium (UHC) academic medical centers in the United States. HAPU incidence rates were calculated as a ratio of HAPU cases to the total number of UHC inpatients between the first quarter of 2008 and the second quarter of 2012. HAPU cases were defined by multiple criteria: not present on admission (POA); coded for stage III or IV pressure ulcers; and a length of stay greater than four days.
Among the UHC hospitals between 2008 and June 2012, 10,386 HAPU cases were identified among 4.08 million inpatients. The HAPU incidence rate decreased significantly from 11.8 cases per 1,000 inpatients in 2008 to 0.8 cases per 1,000 in 2012 (p < .001; 95% confidence interval: 8.39-8.56). Among HAPU cases were trends of more elderly patients, greater case-mix index, and more surgical cases. The analysis of covariance model identified CMS non-payment policy as a significant covariate of changing trends in HAPU incidence rates.
HAPU incidence rates decreased significantly among 210 UHC AMCs after the enactment of the CMS nonpayment policy. The hospitals appeared to be reacting efficiently to economic policy incentives by improving prevention efforts.
2007年，医疗保险和医疗补助服务中心（CMS）宣布，将不再为医院获得性压疮（HAPU）及其他一系列医院获得性疾病（HAC）所产生的费用向医院报销，随后在2008年10月颁布了不予支付政策。本研究旨在确定自2008年以来HAPU发病率及变异情况的变化。
在一项回顾性观察研究中，在美国210家大学卫生系统联盟（UHC）学术医疗中心识别HAPU病例。HAPU发病率计算为2008年第一季度至2012年第二季度期间HAPU病例数与UHC住院患者总数的比率。HAPU病例由多个标准定义：入院时不存在（POA）；编码为III期或IV期压疮；住院时间超过4天。
在2008年至2012年6月期间的UHC医院中，在408万住院患者中识别出10386例HAPU病例。HAPU发病率从2008年的每1000名住院患者11.8例显著下降至2012年的每1000名0.8例（p <.001；95%置信区间：8.39 - 8.56）。在HAPU病例中，存在老年患者更多、病例组合指数更高以及手术病例更多的趋势。协方差分析模型将CMS不予支付政策确定为HAPU发病率变化趋势的一个显著协变量。
CMS不予支付政策颁布后，210家UHC学术医疗中心的HAPU发病率显著下降。医院似乎通过加强预防措施对经济政策激励做出了有效反应。
