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Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
BMJ. 2019 07 03; 366:l4109.BMJ

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.

Authors+Show Affiliations

University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA. University of Michigan Medical School, Ann Arbor, MI, USA.University of Michigan Medical School, Ann Arbor, MI, USA.Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA. Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA.University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA. University of Michigan Medical School, Ann Arbor, MI, USA.University of Michigan Gerald R Ford School of Public Policy, Ann Arbor, MI, USA.University of Michigan Medical School, Ann Arbor, MI, USA. Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA. Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA amryan@umich.edu. Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA. Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31270062

Citation

Sankaran, Roshun, et al. "Changes in Hospital Safety Following Penalties in the US Hospital Acquired Condition Reduction Program: Retrospective Cohort Study." BMJ (Clinical Research Ed.), vol. 366, 2019, p. l4109.
Sankaran R, Sukul D, Nuliyalu U, et al. Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study. BMJ. 2019;366:l4109.
Sankaran, R., Sukul, D., Nuliyalu, U., Gulseren, B., Engler, T. A., Arntson, E., Zlotnick, H., Dimick, J. B., & Ryan, A. M. (2019). Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study. BMJ (Clinical Research Ed.), 366, l4109. https://doi.org/10.1136/bmj.l4109
Sankaran R, et al. Changes in Hospital Safety Following Penalties in the US Hospital Acquired Condition Reduction Program: Retrospective Cohort Study. BMJ. 2019 07 3;366:l4109. PubMed PMID: 31270062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study. AU - Sankaran,Roshun, AU - Sukul,Devraj, AU - Nuliyalu,Ushapoorna, AU - Gulseren,Baris, AU - Engler,Tedi A, AU - Arntson,Emily, AU - Zlotnick,Hanna, AU - Dimick,Justin B, AU - Ryan,Andrew M, Y1 - 2019/07/03/ PY - 2019/7/5/entrez PY - 2019/7/5/pubmed PY - 2019/7/12/medline SP - l4109 EP - l4109 JF - BMJ (Clinical research ed.) JO - BMJ VL - 366 N2 - 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/31270062/Changes_in_hospital_safety_following_penalties_in_the_US_Hospital_Acquired_Condition_Reduction_Program:_retrospective_cohort_study_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=31270062 DB - PRIME DP - Unbound Medicine ER -