Search results for "Hospitals"

Improving safety in health care organizations requires commitment from senior leadership and governance. It also requires an organizational structure that facilitates identifying and addressing safety issues. This study describes the organizational structure used at Johns Hopkins Medicine to prioritize improving quality, safety, and value. The organization developed a reporting and oversight framework using four key principles: governance from the hospital board's dedicated patient safety and quality committee, shared accountability between the board and clinical leadership, a consolidated quality performance statement to ensure transparency around goals and priorities, and internal audits to ensure reliability and accuracy of safety and quality data. The authors provide examples of how this framework was used to address safety issues such as health care–associated infections. An earlier article described Johns Hopkins' success at achieving consistently high performance on accountability measures.

The Centers for Medicare and Medicaid Services (CMS) decision to withhold payment for certain hospital-acquired conditions has prompted widespread efforts to prevent such events, including health care–associated infections. Prior research suggests that academic centers and safety-net hospitals may be disproportionately affected by financial penalties imposed by CMS through various pay-for-performance initiatives. In this study, investigators analyzed how hospital size affected performance in the Hospital-Acquired Condition Reduction Program. They concluded that hospital size leads to bias when evaluating hospital performance, disproportionately penalizing larger hospitals when the expected complication rate for a particular event is low. The authors provide numerous suggestions for improving the evaluation of hospital performance within the program.

The Centers for Medicare and Medicaid Services policy on nonpayment for certain hospital-acquired conditions serves as a strong incentive to prevent adverse events during hospitalization. This observational study examined Medicare's nonpayment policy for conditions such as health care–associated infections. As with prior studies, investigators determined that the incidence of hospital-acquired conditions declined following implementation of nonpayment. For certain conditions, such as catheter-associated urinary tract infections, hospitals with a larger proportion of Medicare patients had greater improvements. The authors note the variation in rates of hospital-acquired conditions and differing magnitude of improvement. They recommend further study to understand how to achieve similar successes in reducing hospital-acquired conditions.

Communication-and-resolution programs underscore the importance of early disclosure of medical error to patients and families. Prior research highlights implementation challenges associated with these efforts. Investigators analyzed 125 adverse event cases from 5 New York City hospitals over a 22-month period following the implementation of communication-and-resolution programs. The majority of cases did not involve substandard care, and disclosure occurred in more than 90% of cases.

Health care–associated infections occur across various health care settings. AHRQ seeks to support large research (R01) and dissemination (R18) projects working to develop strategies and approaches for preventing and reducing health care–associated infections. Applications will be accepted on a standard submission schedule through January 26, 2021 for the R18 funding and March 6, 2021 for the R01 funding.

The Partnership for Patients program is credited with supporting harm reduction in hospitalized patients across the United States through the Hospital Engagement Networks (HEN). This fact sheet summarizes the next round of funding that will build on HEN accomplishments to support innovation with a goal of reducing hospital-acquired conditions and preventable readmissions by 2019.

The AHA-McKesson Quest for Quality Prize winners are recognized for commitment to the goals outlined in Crossing the Quality Chasm. These webinars shared insights from health care organizations that received recognition in 2015 for implementing programs to form partnerships with patients, families, and their communities to generate improvements in health care and eliminate harm.

Despite efforts to enhance health care safety, there is limited evidence that patients are receiving safer care. Reviewing current strategies to generate improvements like pay for performance, this commentary suggests that focusing on clinicians' intrinsic motivation can help improve quality and highlights the Keystone ICU project as a program that successfully motivated its participants. The authors recommend strategies to augment clinician motivation, including unit-level incentives.

Hospital-acquired conditions (HACs) are thought to be preventable, and the Centers for Medicare and Medicaid Services reduces payments to hospitals with the highest rates of these conditions. This analysis sought to assess the association between measures of hospital quality, such as accreditation, and penalties for HACs. Researchers found that accredited hospitals were more likely to incur HAC penalties. Teaching institutions, hospitals whose case mix included more complex patients, and safety-net hospitals were all more likely to face penalties than nonteaching, nonsafety institutions with healthier patients. These results add weight to concerns about unintended consequences of pay-for-performance programs leading to widening health disparities and selective treatment, or "cherry-picking" of healthier patients. A related editorial co-authored by two United States Senators calls for including socioeconomic status in the HAC penalty formula.

Although California has collected an estimated $15 million in penalties from hospitals for adverse events, this news piece describes how much of the money has yet to be allocated or spent on safety improvement projects. Moreover, some state agencies have been reluctant to provide specific data to projects that have already been funded.

This three-component funding program will support collaborative research, program distribution, and project development projects that explore strategies to reduce medical error in both routine hospital settings and intensive care units.

Financial incentives have shown both benefits and limitations in driving efforts to improve patient safety. This news article reports on Medicare penalties for hospitals with high rates of infections and other hospital-acquired conditions that have been designated as primary contributors to patient harm, longer hospitalizations, and unnecessary cost.

This retrospective study found that providing resident and fellow physicians with a financial incentive to meet inpatient quality improvement goals led to enhanced patient safety processes, such as hospital-to-home transitions and timely completion of discharge summaries. These findings highlight a need for broader implementation of trainee incentives as part of quality improvement.

Health care–associated infections (HAIs) remain a major contributor to preventable morbidity and mortality in hospitalized patients, despite some progress in combating certain infections. This economic analysis combined a systematic review of estimates of costs attributable to HAIs with HAI incidence data to project hospitals' total financial burden caused by these infections in adult inpatients. The authors conclude that the 5 most common HAIs result in an annual cost to the health care system of nearly $10 billion. Since the majority of HAIs are considered preventable, this finding implies that considerable savings could be achieved through more rigorous HAI prevention efforts. Although the study is limited by the heterogeneous methods of determining costs used in the original studies, other studies have shown a relatively strong business case for hospitals to invest in efforts to prevent HAIs.

An inconvenient truth about the patient safety movement is that in many cases hospitals actually profit when errors occur. A recent study found that hospitals received greater net reimbursements for patients who experienced surgical complications compared with patients whose surgeries were uncomplicated. This study examined the financial impact of an effort to eliminate obstetric complications in a five-hospital health system. The project led to an 11% reduction in preventable adverse events, but hospital reimbursements decreased considerably as a result—meaning that although costs were saved, the hospitals' net revenues declined overall. This finding represents a classic case of misaligned incentives: the outcome was beneficial for payers and patients (who received higher quality care at lower cost) but not directly beneficial for hospitals (who shouldered the cost of implementing the intervention but lost revenue as a result). As the return on investment for safety interventions such as computerized provider order entry is marginal at best, payment system reform to align incentives will be necessary in order to improve the business case for safety.

Central line–associated bloodstream infections (CLABSI) can be nearly eliminated through implementation of a safety bundle. Prior studies have argued that these interventions are cost effective because the money saved by preventing infections is greater than the cost of the program itself. This study substantiates these significant savings in hospital costs by avoiding CLABSI, but it finds a concomitant marked decrease in hospital reimbursement rates. Under the fee-for-service system, hospitals net a margin of approximately $55,000 for patients that develop CLABSI versus $6,500 in those that do not. Therefore, the business case for this quality improvement measure is purely for the payers, and the decrease in hospital margins for line infections sets up a "perverse incentive" for medical centers. This study adds to recent similar findings that surgical complications also often result in net profits for medical centers.

Harvard internist Dr. Jha is a national leader in policy issues related to safety and quality.

This piece discusses efforts to promote the business case for safety and quality in health care.

The business case for patient safety relies on the assumption that adverse events are financially harmful to hospitals over the long term, so up-front investment in safety improvement will eventually result in savings. However, this study cogently demonstrates that—at least for the specific case of surgical complications—hospitals actually profit when patients experience adverse events. Analysis of more than 30,000 surgical procedures revealed that hospitals received significantly greater net reimbursement for patients who experienced complications compared with those who had no complications. This disparity was particularly evident for patients with private insurance, although it was present to a lesser extent for patients with Medicare. This counterintuitive finding vividly demonstrates that, despite efforts such as the Centers for Medicare and Medicaid Services' policy of not paying for errors, payment incentives are not aligned to the extent that would truly encourage innovative approaches to improving safety. As the noted health economist Dr. Uwe Reinhart points out in his accompanying editorial, the findings of this study arise directly from a payment system that rewards providers for the volume rather than the quality of service provided.

In 2008, the Centers for Medicare and Medicaid Services (CMS) eliminated reimbursement for certain preventable errors and hospital-acquired infections. This landmark policy aimed to align financial disincentives with adverse events, an increasingly utilized strategy. However, this AHRQ-funded study found that the "no pay for errors" policy had no measurable effect on rates of catheter–associated bloodstream infections and catheter–associated urinary tract infections in hospitals in the United States. No subgroup of hospitals or patients identified in this national evaluation seemed to clearly benefit from this policy change. The benefits and limitations of the CMS policy are discussed in an AHRQ WebM&M interview with Dr. Robert Wachter.