Impact of Hospital Operating Margin on Central Line–Associated Bloodstream Infections Following Medicare’s Hospital-Acquired Conditions Payment Policy

2015 ◽  
Vol 37 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Michael S. Calderwood ◽  
Louise E. Vaz ◽  
Alison Tse Kawai ◽  
Robert Jin ◽  
Melisa D. Rett ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Differential Impact ◽  
Payment Policy ◽  
Operating Margin ◽  
Hospital Acquired Conditions ◽  
Operating Margins ◽  
Additional Payment ◽  
Hospital Acquired ◽  
Present On Admission

AbstractIn October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. We evaluated the policy’s differential impact in hospitals with high vs low operating margins. Medicare’s payment policy may have had an impact on reducing central line–associated bloodstream infections in hospitals with low operating margins.Infect. Control Hosp. Epidemiol. 2015;37(1):100–103

Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections

2015 ◽  
Vol 36 (8) ◽  
pp. 871-877 ◽  
Author(s):  
Alison Tse Kawai ◽  
Michael S. Calderwood ◽  
Robert Jin ◽  
Stephen B. Soumerai ◽  
Louise E. Vaz ◽  
...  
Keyword(s):  
New York ◽  
Odds Ratio ◽  
Times Series ◽  
Hospital Acquired Conditions ◽  
Medicare Patients ◽  
Study Population ◽  
Tract Infections ◽  
Additional Payment ◽  
Healthcare Associated ◽  
Hospital Acquired

BACKGROUNDThe 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.OBJECTIVETo examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).STUDY POPULATIONAdult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.DESIGNWe used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.RESULTSBefore the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11–1.23]; for CAUTI, 1.19 [1.16–1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69–0.81]; for CAUTI, 0.87 [0.79–0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97–0.99]; for CAUTI, 0.99 [0.97–1.00]).CONCLUSIONSThe Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.Infect. Control Hosp. Epidemiol. 2015;36(8):871–877

Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy Evidence for a Proposed Modification to the Current Surveillance Definition

2013 ◽  
Vol 34 (2) ◽  
pp. 171-175 ◽  
Author(s):  
James P. Steinberg ◽  
Chad Robichaux ◽  
Sheri Chernetsky Tejedor ◽  
Mary Dent Reyes ◽  
Jesse T. Jacob
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
University Hospitals ◽  
Central Venous ◽  
E Coli ◽  
National Healthcare Safety Network ◽  
Proposed Modification ◽  
Definition Of ◽  
Hospital Acquired ◽  
Study Hospital

Objective.Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line-associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.Design.Retrospective review.Setting.Two large university hospitals over 18 months.Methods.All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.Results.Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group includedEscherichia coli(22.7% vs 2.5%;P< .001) but not other Enterobacteriaceae,Enterococcus faecium(18.2% vs 6.1%;P= .002), and streptococci (18.2% vs 0%;P< .001). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, orE. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.Conclusions.Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.

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

2015 ◽  
Vol 36 (6) ◽  
pp. 649-655 ◽  
Author(s):  
Louise Elaine Vaz ◽  
Kenneth P. Kleinman ◽  
Alison Tse Kawai ◽  
Robert Jin ◽  
William J. Kassler ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Financial Incentives ◽  
Safety Net ◽  
The United States ◽  
Central Line ◽  
Unintended Consequences ◽  
Infection Rates ◽  
Healthcare Associated Infection ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

BACKGROUNDPolicymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.OBJECTIVETo 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.DESIGNInterrupted time-series design.SETTING AND PARTICIPANTSNonfederal 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.RESULTSWe 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).CONCLUSIONSThe 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

scholarly journals Comparison of Total Hospital-Acquired Bloodstream Infections to Central Line–Associated Bloodstream Infections and Implications for Outcome Measures in Infection Control

2013 ◽  
Vol 34 (9) ◽  
pp. 984-986 ◽  
Author(s):  
Surbhi Leekha ◽  
Shanshan Li ◽  
Kerri A. Thom ◽  
Michael Anne Preas ◽  
Brian S. Caffo ◽  
...  
Keyword(s):  
Intensive Care ◽  
Infection Control ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Outcome Measures ◽  
Bloodstream Infections ◽  
Central Line ◽  
Total Hospital ◽  
Prevention Intervention ◽  
Hospital Acquired

The validity of the central line-associated bloodstream infection (CLABSI) measure is compromised by subjectivity. We observed significant decreases in both CLABSIs and total hospital-acquired bloodstream infections (BSIs) following a CLABSI prevention intervention in adult intensive care units. Total hospital-acquired BSIs could be explored as an adjunct, objective CLABSI measure.

Attributable Mortality for Pediatric and Neonatal Central Line-Associated Bloodstream Infections in Greece

2021 ◽  
Author(s):  
Sofia Karagiannidou ◽  
Georgia Kourlaba ◽  
Theoklis Zaoutis ◽  
Nikolaos Maniadakis ◽  
Vassiliki Papaevangelou
Keyword(s):  
Infection Prevention ◽  
Statistical Significance ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Attributable Mortality ◽  
Time To Death ◽  
Study Enrollment ◽  
Pediatric Hospitals ◽  
Hospital Acquired

AbstractCentral line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and significantly impact outcomes. The aim of this study was to estimate the attributable mortality for CLABSIs in pediatric and neonatal patients in Greece. A retrospective matched-cohort study was performed, in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units (NICUs and PICUs), hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to non-CLABSI patients by hospital, hospitalization unit, and length of stay prior to study enrollment (188 children enrolled, 94 CLABSIs). Attributable mortality was estimated. During the study period, 22 CLABSIs and nine non-CLABSIs died (23.4 vs. 9.6%, respectively, p = 0.011), leading to an attributable mortality of 13.8% (95% confidence interval [CI] = 3.4–24.3%). Children in PICUs were more likely to die, presenting an attributable mortality of 20.2% (95% CI = − 1.4–41.8%), without reaching, however, statistical significance. After multiple logistic regression, CLABSIs were four times more likely to die (odds ratio [OR] = 4.29, 95% CI = 1.28–14.36, p = 0.018). Survival analysis showed no difference in time to death after study enrollment between CLABSIs and non-CLABSIs (log-rank p = 0.137, overall median survival time = 7.8 months). Greek pediatric mortality rates are increased by the CLABSI occurrence, highlighting the importance of infection prevention strategies.

Modern Trends in Infection Control Practices in Intensive Care Units

2013 ◽  
Vol 29 (6) ◽  
pp. 311-326 ◽  
Author(s):  
Sumanth Gandra ◽  
Richard T. Ellison
Keyword(s):  
Intensive Care ◽  
Infection Control ◽  
Infection Prevention ◽  
Bloodstream Infections ◽  
Central Line ◽  
Environmental Cleaning ◽  
Hospital Acquired Infections ◽  
New Methods ◽  
Tract Infections ◽  
Hospital Acquired

Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.

Sign in / Sign up

Export Citation Format

Share Document