Evaluation of hospital-acquired conditions reduction program in surgical procedures

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Quality Improvement

Background:

• The Centers for Medicare & Medicaid Services (CMS) implemented the Hospital-Acquired Conditions Reduction Program (HACRP) to penalize hospitals with high rates of specific hospital-acquired conditions (HACs).
• Surgical site infections (SSIs) are a significant concern, particularly following abdominal hysterectomy and colon procedures.

Purpose of the Study:

• To evaluate the impact of the HACRP on the incidence of SSIs for abdominal hysterectomy and colon procedures.
• To assess the effectiveness of the HACRP in reducing targeted hospital-acquired conditions.

Main Methods:

• A quasi-experimental difference-in-differences (DID) method was employed.
• Analysis utilized data from the National (Nationwide) Inpatient Sample (NIS) spanning January 2012 to September 2015.
• Models controlled for patient and hospital characteristics to isolate program effects.

Main Results:

• The DID estimates for the impact of HACRP on SSIs were statistically insignificant.
• Results remained robust across various sensitivity analyses, indicating no direct effect on the targeted SSIs.
• The study highlights potential limitations, including administrative SSI code accuracy and control group comparability.

Conclusions:

• The HACRP, as implemented, did not demonstrate a direct impact on reducing SSIs for the studied procedures.
• Further research with more granular data and improved methodologies is recommended to validate findings and enhance the HACRP.
• Suggestions for program improvement include refining measurement design, enhancing communication, and exploring alternative penalty structures.