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Area of Science:

  • Health Services Research
  • Healthcare Policy
  • Infectious Disease Epidemiology

Background:

  • Value-based incentive programs in the US often penalize safety-net institutions more than non-safety-net ones.
  • The impact of these programs on healthcare-associated infections (HAIs) in different hospital types remains unclear.

Purpose of the Study:

  • To evaluate the association between the Hospital-Acquired Condition Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) and changes in HAI rates.
  • To examine disparities in HAI rates between safety-net and non-safety-net hospitals following program implementation.

Main Methods:

  • An interrupted time series analysis of US acute care hospitals from 2013-2018.
  • Inclusion of data on hospital characteristics, penalty statuses, and rates of four targeted HAIs: CLABSI, CAUTI, and two types of SSI.
  • Generalized estimating equations were used to assess program impact on HAI rates and disparities.

Main Results:

  • HACRP and HVBP implementation showed no association with improvements in any of the targeted HAI rates for either hospital type.
  • Safety-net hospitals consistently had higher rates of CLABSI, CAUTI, and colon SSI before and after program implementation.
  • Disparities in infection rates between safety-net and non-safety-net hospitals persisted post-implementation.

Conclusions:

  • The studied value-based incentive programs did not reduce HAI rates or disparities in safety-net hospitals.
  • These findings suggest that HACRP and HVBP may function as a penalty system for safety-net hospitals without demonstrating patient-level benefits.
  • Further research is needed to understand and address persistent HAI disparities in vulnerable healthcare settings.