Padula WV, Makic MB, Wald HL, Campbell JD, Nair KV, Mishra MK, Valuck RJ, et al.
Joint Commission journal on quality and patient safety. Date of publication 2015 Jun 1;volume 41(6):257-63.
1. Jt Comm J Qual Patient Saf. 2015 Jun;41(6):257-63.
Hospital-Acquired Pressure Ulcers at Academic Medical Centers in the United
States, 2008-2012: Tracking Changes Since the CMS Nonpayment Policy.
Padula WV(1), Makic MB, Wald HL, Campbell JD, Nair KV, Mishra MK, Valuck RJ.
Author information:
(1)Section of Hospital Medicine, University of Chicago, USA.
BACKGROUND: In 2007, the Centers for Medicare & Medicaid Services (CMS) announced
its intention to no longer reimburse hospitals for costs associated with
hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired
conditions (HACs), which was followed by enactment of the nonpayment policy in
October 2008. This study was conducted to define changes in HAPU incidence and
variance since 2008.
METHODS: In a retrospective observational study, HAPU cases were identified at
210 University HealthSystem Consortium (UHC) academic medical centers in the
United States. HAPU incidence rates were calculated as a ratio of HAPU cases to
the total number of UHC inpatients between the first quarter of 2008 and the
second quarter of 2012. HAPU cases were defined by multiple criteria: not present
on admission (POA); coded for stage III or IV pressure ulcers; and a length of
stay greater than four days.
RESULTS: Among the UHC hospitals between 2008 and June 2012, 10,386 HAPU cases
were identified among 4.08 million inpatients. The HAPU incidence rate decreased
significantly from 11.8 cases per 1,000 inpatients in 2008 to 0.8 cases per 1,000
in 2012 (p < .001; 95% confidence interval: 8.39-8.56). Among HAPU cases were
trends of more elderly patients, greater case-mix index, and more surgical cases.
The analysis of covariance model identified CMS non-payment policy as a
significant covariate of changing trends in HAPU incidence rates.
CONCLUSIONS: HAPU incidence rates decreased significantly among 210 UHC AMCs
after the enactment of the CMS nonpayment policy. The hospitals appeared to be
reacting efficiently to economic policy incentives by improving prevention
efforts.
PMID: 25990891 [Indexed for MEDLINE]
