As 2015 drew to a close, the Agency for Healthcare Research and Quality announced some good news: Fewer US patients are dying from hospital-acquired conditions (HACs) like pressure ulcers and catheter-associated infections. Between 2011 and 2014, patients had 2.1 million fewer HACs than they would have if the 2010 baseline rate had continued. The drop translated to an estimated $20 billion in healthcare-cost savings and 87,000 fewer deaths.
Of the HACs averted over the four-year period, 40% were adverse drug events, 28% were pressure ulcers, and 16% were catheter-associated urinary tract infections. AHRQ’s report explains that the reasons for the HAC decline aren’t fully understood, but it highlights some things that probably helped:
Likely contributing causes are financial incentives created by CMS and other payers' payment policies, public reporting of hospital-level results, technical assistance offered by the QIO program to hospitals, and technical assistance and catalytic efforts of the HHS PfP [Partnership for Patients] initiative led by CMS. Numerous other public and private initiatives to improve healthcare quality and patient safety were implemented during these years; for example, the widespread implementation and improved use of Electronic Health Records at hospitals. And crucially, the progress was made possible by the results of investments made by the Agency for Healthcare Research and Quality in producing evidence about how to make care safer, investing in tools and training to catalyze improvement, and investments in data and measures to be able to track change.
The HHS news release about the HAC findings describes some of the relevant AHRQ tools:
AHRQ has produced a variety of tools and resources to help hospitals and other providers prevent hospital-acquired conditions, such as reducing infections, pressure ulcers, and falls. Recently the agency released the Toolkit for Reducing CAUTI in Hospitals, which is based on the experiences of more than 1,200 hospitals nationwide that participated in an AHRQ-funded project to apply the Comprehensive Unit-based Safety Program to reducing catheter associated urinary tract infections (CAUTI). Preliminary data indicate that hospitals using these tools reduced CAUTIs by approximately 15 percent overall. AHRQ works with its HHS colleagues and researchers across the country to create new knowledge about how to improve care, particularly in understudied areas such as diagnostic error and antibiotic resistance.
As these paragraphs make clear, there isn’t one single solution to reducing hospital-acquired conditions – much as there isn’t one single solution to reducing US healthcare costs while providing high-quality care. Having good data is essential for knowing where the problems are, and whether new initiatives to address them actually work. Progress may seem maddeningly incremental at times, but it is possible, as this new AHRQ report demonstrates. The many health professionals who’ve contributed to reducing hospital-acquired conditions should be proud of what they’ve accomplished.
You might also note that the " financial incentives created by CMS and other payers’ payment policies" were the direct creation of the Affordable Care Act (ACA/Obamacare) which established the Hospital-Acquired Condition Reduction Program in section 3008. See https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpa…