Changes in Hospital-acquired Conditions and Mortality Associated With the Hospital-acquired Condition Reduction Program.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 10 2021
01 10 2021
Historique:
entrez:
10
9
2021
pubmed:
11
9
2021
medline:
6
10
2021
Statut:
ppublish
Résumé
To improve patient safety, the Centers for Medicare and Medicaid Services announced the Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The program reduces Medicare payments by 1% for hospitals in the lowest performance quartile related to hospital-acquired conditions. Performance measures are focused on perioperative care. To evaluate changes in HACs and 30-day mortality after the announcement of the HACRP. Interrupted time-series design using Medicare Provider and Analysis Review (MEDPAR) claims data. We estimated models with linear splines to test for changes in HACs and 30-day mortality before the Affordable Care Act (ACA), after the ACA, and after the HACRP. Fee-for-service Medicare 2009-2015. Medicare beneficiaries undergoing surgery and discharged from an acute care hospital between January 2009 and August 2015 (N = 8,857,877). Changes in HACs and 30-day mortality after the announcement of the HACRP. Patients experienced HACs at a rate of 13.39 per 1000 discharges [95% confidence interval (CI), 13.10 to 13.68] in the pre-ACA period. This declined after the ACA was passed and declined further after the HACRP announcement [adjusted difference in annual slope, -1.34 (95% CI, -1.64 to -1.04)]. Adjusted 30-day mortality was 3.69 (95% CI, 3.64 to 3.74) in the pre-ACA period among patients receiving surgery. Thirty-day mortality continued to decline after the ACA [adjusted annual slope -0.04 (95% CI, -0.05 to -0.02)] but was flat after the HACRP [adjusted annual slope -0.01 (95% CI, -0.04 to 0.02)]. Although hospital-acquired conditions targeted under the HACRP declined at a greater rate after the program was announced, 30-day mortality was unchanged.
Identifiants
pubmed: 34506324
doi: 10.1097/SLA.0000000000003641
pii: 00000658-202110000-00018
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e301-e307Subventions
Organisme : NIA NIH HHS
ID : R01 AG047932
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS026244
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG039434
Pays : United States
Informations de copyright
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
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