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Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program.
- Source :
-
American journal of medical quality : the official journal of the American College of Medical Quality [Am J Med Qual] 2017 Nov/Dec; Vol. 32 (6), pp. 611-616. Date of Electronic Publication: 2016 Dec 19. - Publication Year :
- 2017
-
Abstract
- In 2016, Medicare's Hospital-Acquired Condition Reduction Program (HAC-RP) will reduce hospital payments by $364 million. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the assignment of penalties. This study investigated possible bias in the HAC-RP by simulating hospitals' likelihood of being in the worst-performing quartile for 8 patient safety measures, assuming identical expected complication rates across hospitals. Simulated likelihood of being a poor performer varied with hospital size. This relationship depended on the measure's complication rate. For 3 of 8 measures examined, the equal-quality simulation identified poor performers similarly to empirical data (c-statistic approximately 0.7 or higher) and explained most of the variation in empirical performance by size (Efron's R <superscript>2</superscript> > 0.85). The Centers for Medicare & Medicaid Services could address potential bias in the HAC-RP by stratifying by hospital size or using a broader "all-harm" measure.
- Subjects :
- Centers for Medicare and Medicaid Services, U.S. standards
Hospital Bed Capacity standards
Humans
Patient Safety standards
Quality Indicators, Health Care standards
United States
Centers for Medicare and Medicaid Services, U.S. statistics & numerical data
Hospital Bed Capacity statistics & numerical data
Iatrogenic Disease epidemiology
Patient Safety statistics & numerical data
Quality Indicators, Health Care statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1555-824X
- Volume :
- 32
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of medical quality : the official journal of the American College of Medical Quality
- Publication Type :
- Academic Journal
- Accession number :
- 28693333
- Full Text :
- https://doi.org/10.1177/1062860616681840