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The Impact of the Medicaid Healthcare-Associated Condition Program on Mediastinitis Following Coronary Artery Bypass Graft

Published online by Cambridge University Press:  19 April 2018

Heather E. Hsu ,
Alison Tse Kawai ,
Rui Wang ,
Maximilian S. Jentzsch ,
Chanu Rhee ,
Kelly Horan ,
Robert Jin ,
Donald Goldmann  and
Grace M. Lee
Heather E. Hsu*
Affiliation:
Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Alison Tse Kawai
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Rui Wang
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Maximilian S. Jentzsch
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Chanu Rhee
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Kelly Horan
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Robert Jin
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Donald Goldmann
Affiliation:
Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Institute for Healthcare Improvement, Cambridge, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
*
Address correspondence to Heather Hsu, MD MPH, Harvard Pilgrim Health Care Institute, 401 Park Drive #401, Boston, MA 02215 (heather.hsu@childrens.harvard.edu).
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Abstract

OBJECTIVE

In 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with the rates of a condition not targeted by the program, deep-space surgical site infection (SSI) after knee replacement.

DESIGN

Interrupted time series with comparison group.

METHODS

We included surveillance data from nonfederal acute-care hospitals participating in the NHSN and reporting CABG or knee replacement outcomes from January 2009 through June 2017. We examined the Medicaid program’s impact on NHSN-reported infection rates, adjusting for secular trends. The data analysis used generalized estimating equations with robust sandwich variance estimators.

RESULTS

During the study period, 196 study hospitals reported 273,984 CABGs to the NHSN, resulting in 970 mediastinitis cases (0.35%), and 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep-space SSIs (0.32%). There was no significant change in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the postprogram versus preprogram periods (P=.70) or an immediate program effect (P=.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect.

CONCLUSIONS

The 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.

Infect Control Hosp Epidemiol 2018;39:694–700

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 6 , June 2018 , pp. 694 - 700
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. Preliminary data for this analysis were presented at the 2017 National Research Service Award (NRSA) Conference on June 24, 2017, in New Orleans, Louisiana.

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