Wood Dan M, Beauvais Brad, Sturdivant Rodney X, Kim Forest S
Graduate Program in Health and Business Administration, Army-Baylor University, San Antonio, TX, USA.
School of Health Administration, Texas State University, San Marcos, TX, USA.
Risk Manag Healthc Policy. 2024 Sep 7;17:2181-2190. doi: 10.2147/RMHP.S469424. eCollection 2024.
This study explores the effects of CMS reimbursement financial penalties from the Hospital-Acquired Condition Reduction Program (HACRP) on hospital-acquired infections (HAI) in hospitals across the United States.
Hospital-level data for 2896 hospitals in the United States were evaluated using multiple linear regression models with random effects analysis through a difference-in-differences study design to examine HAIs under the HACRP between hospitals that were financially penalized or not from calendar years 2013 to 2020.
This study showed significant differences from the pre-program Total HAC scores to the most recent reviewed year, validating the efficacy of the HACRP, and showing a reduction of overall HAIs over the years evaluated in the study. The multiple linear regression model with random effects analysis produced a significant ( < 0.001) interaction term between hospitals expected to be penalized in 2013 and each year evaluated in the study (-0.412 estimate) confirming decreases in HAI scores, and overall decreases in HAIs across the years of the study. Notably, 98% of hospitals in the worst-performing, expected to be financially penalized quartile from 2013, were found to have decreased their HAIs in their facilities, while only 38.8% of hospital in the performing, non-penalized quartiles showed decreases in HAIs across their facilities, by 2020.
Our research indicates that implementing financial disincentives through reimbursement reductions could potentially decrease the incidence of HAIs. Our study further suggests that incorporating financial penalties and incentives for HAIs annually across all hospitals may lead to significant reductions in HAIs throughout the US healthcare system.
本研究探讨医疗保险和医疗补助服务中心（CMS）针对医院获得性疾病减少计划（HACRP）实施的报销财务处罚对美国各医院医院获得性感染（HAI）的影响。
通过双重差分研究设计，使用具有随机效应分析的多元线性回归模型，对美国2896家医院的医院层面数据进行评估，以研究2013年至2020年期间受到或未受到财务处罚的医院在HACRP下的医院获得性感染情况。
本研究显示，从计划实施前的总HAC分数到最近一次审查年份存在显著差异，验证了HACRP的有效性，并表明在本研究评估的年份中总体医院获得性感染有所减少。具有随机效应分析的多元线性回归模型在预计2013年受到处罚的医院与研究中评估的每年之间产生了显著（<0.001）的交互项（估计值为-0.412），证实了医院获得性感染分数的下降以及研究各年份中总体医院获得性感染的下降。值得注意的是，到2020年，预计在2013年处于表现最差、预计受到财务处罚四分位数的医院中，98%的医院其设施内的医院获得性感染有所减少，而在表现良好、未受处罚四分位数的医院中，只有38.8%的医院其设施内的医院获得性感染有所减少。
我们的研究表明，通过减少报销实施财务抑制措施可能会降低医院获得性感染的发生率。我们的研究进一步表明，每年对所有医院的医院获得性感染实施财务处罚和激励措施，可能会使美国医疗保健系统中的医院获得性感染显著减少。
