scholarly journals Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study

BMJ ◽  
2019 ◽  
pp. l4109 ◽  
Author(s):  
Roshun Sankaran ◽  
Devraj Sukul ◽  
Ushapoorna Nuliyalu ◽  
Baris Gulseren ◽  
Tedi A Engler ◽  
...  
Keyword(s):  
Acute Care ◽  
Retrospective Cohort ◽  
Acute Care Hospitals ◽  
The United States ◽  
Fiscal Year ◽  
Percentage Points ◽  
Hospital Acquired Conditions ◽  
The Us ◽  
Reduction Program ◽  
Hospital Acquired

Abstract Objective To evaluate the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and subsequent changes in clinical outcomes. Design Regression discontinuity design applied to a retrospective cohort from inpatient Medicare claims. Setting 3238 acute care hospitals in the United States. Participants Medicare fee-for-service beneficiaries discharged from acute care hospitals between 23 July 2014 and 30 November 2016 and eligible for at least one targeted hospital acquired condition (n=15 470 334). Intervention Hospital receipt of a penalty in the first year of the HACRP. Main outcome measures Episode level count of targeted hospital acquired conditions per 1000 episodes, 30 day readmissions, and 30 day mortality. Results Of 724 hospitals penalized under the HACRP in fiscal year 2015, 708 were represented in the study. Mean counts of hospital acquired conditions were 2.72 per 1000 episodes for penalized hospitals and 2.06 per 1000 episodes for non-penalized hospitals; 30 day readmissions were 14.4% and 14.0%, respectively, and 30 day mortality was 9.0% for both hospital groups. Penalized hospitals were more likely to be large, teaching institutions, and have a greater share of patients with low socioeconomic status than non-penalized hospitals. HACRP penalties were associated with a non-significant change of −0.16 hospital acquired conditions per 1000 episodes (95% confidence interval −0.53 to 0.20), −0.36 percentage points in 30 day readmission (−1.06 to 0.33), and −0.04 percentage points in 30 day mortality (−0.59 to 0.52). No clear patterns of clinical improvement were observed across hospital characteristics. Conclusions Penalization was not associated with significant changes in rates of hospital acquired conditions, 30 day readmission, or 30 day mortality, and does not appear to drive meaningful clinical improvements. By disproportionately penalizing hospitals caring for more disadvantaged patients, the HACRP could exacerbate inequities in care.

Hospital-Acquired Conditions Reduction Program, Patient Safety, and Magnet Designation in the United States

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hanadi Hamadi ◽  
Shalmali R. Borkar ◽  
LaRee Moody DHA ◽  
Aurora Tafili ◽  
J. Scott Wilkes ◽  
...  
Keyword(s):  
United States ◽  
Patient Safety ◽  
The United States ◽  
Hospital Acquired Conditions ◽  
Reduction Program ◽  
Hospital Acquired

Preparation of Children for Hospitalization in Acute Care Hospitals in the United States

PEDIATRICS ◽  
1981 ◽  
Vol 68 (3) ◽  
pp. 361-368
Author(s):  
Pat Azarnoff ◽  
Patricia D. Woody
Keyword(s):  
United States ◽  
Acute Care ◽  
Group Discussion ◽  
Acute Care Hospitals ◽  
The United States ◽  
Pediatric Care ◽  
Children's Hospitals ◽  
General Hospitals ◽  
Psychological Preparation ◽  
Children’S Hospitals

To study the prevalence and nature of psychological preparation for pediatric care, children's hospitals and acute care general hospitals were surveyed, and 24 hospitals were visited. Of 1,427 hospitals responding, 468 (33%) provided regular, planned preparation services. Prior to hospitalization, group tours and group discussion were the two most frequently used methods. During hospitalization, children learned informally as events occurred, usually through conversations.

scholarly journals Freedom Fries

2010 ◽  
Vol 2 (3) ◽  
pp. 256-281 ◽  
Author(s):  
Guy Michaels ◽  
Xiaojia Zhi
Keyword(s):  
United States ◽  
Willingness To Pay ◽  
Bilateral Trade ◽  
The United States ◽  
Average Decrease ◽  
Percentage Points ◽  
The Us

Do firms always choose the cheapest suitable inputs, or can group attitudes affect their choices? To investigate this question, we examine the deterioration of relations between the United States and France from 2002–2003, when France's favorability rating in the US fell by 48 percentage points. We estimate that the worsening attitudes reduced bilateral trade by about 9 percent and that trade in inputs probably declined similarly, by about 8 percent. We use these estimates to calculate the average decrease in firms' willingness to pay for French (or US) commodities when attitudes worsened. (JEL D24, F13, F14, L14, L21)

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

Pressure Ulcers and Prevention Among Acute Care Hospitals in the United States

2013 ◽  
Vol 39 (9) ◽  
pp. 404-414 ◽  
Author(s):  
Sandra Bergquist-Beringer ◽  
Lei Dong ◽  
Jianghua He ◽  
Nancy Dunton
Keyword(s):  
United States ◽  
Acute Care ◽  
Pressure Ulcers ◽  
Acute Care Hospitals ◽  
The United States

Simulation Use in Acute Care Hospitals in the United States

2018 ◽  
Vol 34 (5) ◽  
pp. 242-249 ◽  
Author(s):  
Mary G. Harper ◽  
Gregory E. Gilbert ◽  
Marie Gilbert ◽  
Linda Markey ◽  
Krista Anderson
Keyword(s):  
United States ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
The United States

The occurrence and timing of delirium in acute care hospitalizations in the last year of life: A population-based retrospective cohort study

2020 ◽  
Vol 34 (8) ◽  
pp. 1067-1077
Author(s):  
Colleen Webber ◽  
Christine L Watt ◽  
Shirley H Bush ◽  
Peter G Lawlor ◽  
Robert Talarico ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prevalence Ratio ◽  
Acute Care Hospitals ◽  
Population Based ◽  
Care Hospital ◽  
Factors Associated

Background: Delirium is a distressing neurocognitive disorder that is common among terminally ill individuals, although few studies have described its occurrence in the acute care setting among this population. Aim: To describe the prevalence of delirium in patients admitted to acute care hospitals in Ontario, Canada, in their last year of life and identify factors associated with delirium. Design: Population-based retrospective cohort study using linked health administrative data. Delirium was identified through diagnosis codes on hospitalization records. Setting/participants: Ontario decedents (1 January 2014 to 31 December 2016) admitted to an acute care hospital in their last year of life, excluding individuals age of <18 years or >105 years at admission, those not eligible for the provincial health insurance plan between their hospitalization and death dates, and non-Ontario residents. Results: Delirium was recorded as a diagnosis in 8.2% of hospitalizations. The frequency of delirium-related hospitalizations increased as death approached. Delirium prevalence was higher in patients with dementia (prevalence ratio: 1.43; 95% confidence interval: 1.36–1.50), frailty (prevalence ratio: 1.67; 95% confidence interval: 1.56–1.80), or organ failure–related cause of death (prevalence ratio: 1.23; 95% confidence interval: 1.16–1.31) and an opioid prescription (prevalence ratio: 1.17; 95% confidence interval: 1.12–1.21). Prevalence also varied by age, sex, chronic conditions, antipsychotic use, receipt of long-term care or home care, and hospitalization characteristics. Conclusion: This study described the occurrence and timing of delirium in acute care hospitals in the last year of life and identified factors associated with delirium. These findings can be used to support delirium prevention and early detection in the hospital setting.

Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals

2008 ◽  
Vol 29 (11) ◽  
pp. 1035-1041 ◽  
Author(s):  
Philip C. Carling ◽  
Michael M. Parry ◽  
Mark E. Rupp ◽  
John L. Po ◽  
Brian Dick ◽  
...  
Keyword(s):  
Acute Care ◽  
Performance Feedback ◽  
Hospital Setting ◽  
Acute Care Hospitals ◽  
The United States ◽  
Multidrug Resistant ◽  
Environmental Services ◽  
Environmental Surfaces ◽  
Before And After ◽  
Quasi Experimental

Objective.The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.Design.Prospective quasi-experimental, before-after, study.Setting.Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.Methods.We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.Results.Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).Conclusions.Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.

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