Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston.
JAMA Netw Open. 2024 Feb 5;7(2):e2356196. doi: 10.1001/jamanetworkopen.2023.56196.
The Hospital-Acquired Condition Reduction Program (HACRP) evaluates acute care hospitals on the occurrence of patient safety events and health care-associated infections. Since its implementation, several studies have raised concerns about the overpenalization of teaching and safety-net hospitals, and although several changes in the program's methodology have been applied in the last few years, whether these changes reversed the overpenalization of teaching and safety-net hospitals is unknown.
To determine hospital characteristics associated with HACRP penalization and penalization reversal.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study assessed data from 3117 acute care hospitals participating in the HACRP. The HACRP penalization and hospital characteristics were obtained from Hospital Compare (2020 and 2021), the Inpatient Prospective Payment System impact file (2020), and the American Hospital Association annual survey (2018).
Hospital characteristics, including safety-net status and teaching intensity (no teaching and very minor, minor, major, and very major teaching levels).
The primary outcome was HACRP penalization (ie, hospitals that fell within the worst quartile of the program's performance). Multivariable models initially included all covariates, and then backward stepwise variable selection was used.
Of 3117 hospitals that participated in HACRP in 2020, 779 (25.0%) were safety-net hospitals and 1090 (35.0%) were teaching institutions. In total, 771 hospitals (24.7%) were penalized. The HACRP penalization was associated with safety-net status (odds ratio [OR], 1.41 [95% CI, 1.16-1.71]) and very major teaching intensity (OR, 1.94 [95% CI, 1.15-3.28]). In addition, non-federal government hospitals were more likely to be penalized than for-profit hospitals (OR, 1.62 [95% CI, 1.23-2.14]), as were level I trauma centers (OR, 2.05 [95% CI, 1.43-2.96]) and hospitals located in the New England region (OR, 1.65 [95% CI, 1.12-2.43]). Safety-net hospitals with major teaching levels were twice as likely to be penalized as non-safety-net nonteaching hospitals (OR, 2.15 [95% CI, 1.14-4.03]). Furthermore, safety-net hospitals penalized in 2020 were less likely (OR, 0.64 [95% CI, 0.43-0.96]) to revert their HACRP penalization status in 2021.
Findings from this cross-sectional study indicated that teaching and safety-net hospital status continued to be associated with overpenalization in the HACRP despite recent changes in its methodology. Most of these hospitals were also less likely to revert their penalization status. A reevaluation of the program methodology is needed to avoid depleting resources of hospitals caring for underserved populations.
医院获得性条件减少计划（HACRP）根据患者安全事件和医疗保健相关感染的发生情况对急性护理医院进行评估。自实施以来，已有多项研究对教学和安全网医院过度惩罚的问题表示担忧，尽管该计划的方法学在过去几年中进行了几次修改，但这些修改是否扭转了教学和安全网医院的过度惩罚尚不清楚。
确定与 HACRP 处罚和处罚逆转相关的医院特征。
设计、设置和参与者：本回顾性横断面研究评估了参与 HACRP 的 3117 家急性护理医院的数据。HACRP 的处罚和医院特征来自 Hospital Compare（2020 年和 2021 年）、住院患者前瞻性支付系统影响文件（2020 年）和美国医院协会年度调查（2018 年）。
医院特征，包括安全网状态和教学强度（无教学和轻微、次要、主要和非常主要的教学水平）。
主要结果是 HACRP 处罚（即，属于该计划绩效最差四分之一的医院）。多变量模型最初包括所有协变量，然后使用向后逐步变量选择。
在 2020 年参与 HACRP 的 3117 家医院中，779 家（25.0%）为安全网医院，1090 家（35.0%）为教学机构。共有 771 家医院（24.7%）受到处罚。HACRP 处罚与安全网状态（比值比[OR]，1.41 [95%置信区间，1.16-1.71]）和非常主要的教学强度（OR，1.94 [95%置信区间，1.15-3.28]）相关。此外，与营利性医院相比，非联邦政府医院更有可能受到处罚（OR，1.62 [95%置信区间，1.23-2.14]），1 级创伤中心（OR，2.05 [95%置信区间，1.43-2.96]）和位于新英格兰地区的医院（OR，1.65 [95%置信区间，1.12-2.43]）。具有主要教学水平的安全网医院受到处罚的可能性是非安全网非教学医院的两倍（OR，2.15 [95%置信区间，1.14-4.03]）。此外，2020 年受到处罚的安全网医院在 2021 年更不可能（OR，0.64 [95%置信区间，0.43-0.96]）恢复其 HACRP 处罚状态。
这项横断面研究的结果表明，尽管该计划的方法学最近有所修改，但教学和安全网医院的状况仍然与 HACRP 中的过度处罚有关。这些医院中的大多数也不太可能恢复其处罚状态。需要重新评估该计划的方法，以避免耗尽为服务不足人群提供护理的医院的资源。
