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Impact of Medicare’s Hospital-Acquired Condition Policy on Infections in Safety Net and Non–Safety Net Hospitals

Published online by Cambridge University Press:  03 March 2015

Louise Elaine Vaz*
Affiliation:
Division of Pediatric Infectious Diseases, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland
Kenneth P. Kleinman
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Alison Tse Kawai
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Robert Jin
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
William J. Kassler
Affiliation:
Centers for Medicare and Medicaid Services, Boston, Massachusetts
Patricia S. Grant
Affiliation:
Methodist Hospital for Surgery, Addison, Texas Association for Professionals in Infection Control and Epidemiology, Washington, DC
Melisa D. Rett
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Donald A. Goldmann
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts Institute for Healthcare Improvement, Cambridge, Massachusetts
Michael S. Calderwood
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts Brigham and Women’s Hospital, Boston, Massachusetts
Stephen B. Soumerai
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
*
Address correspondence to Louise Vaz, MD, MPH, Doernbecher Children’s Hospital, Oregon Health & Science University, Mail Code CDRC-P, 707 SW Gaines St, Portland, OR 97239 (vaz@ohsu.edu).

Abstract

BACKGROUND

Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.

OBJECTIVE

To determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non–safety net hospitals.

DESIGN

Interrupted time-series design.

SETTING AND PARTICIPANTS

Nonfederal acute care hospitals that reported central line–associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention’s National Health Safety Network from July 1, 2007, through December 31, 2013.

RESULTS

We did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84–1.09]) or non–safety net (0.99 [0.90–1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non–safety net hospitals (P for 2-way interaction, .87).

CONCLUSIONS

The Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line–associated bloodstream infection in safety net or non–safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.

Infect Control Hosp Epidemiol 2015;00(0): 1–7

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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