HAIs: Hospitals Struggle to Make Consistent Progress
The Department of Health and Human Services released a report highlighting recent improvements in hospital care quality, specifically lower rates of hospital-acquired conditions (HACs). According to the Agency for Healthcare Research and Quality, HACs declined by 21 percent from 2010 to 2015, representing an estimated 125,000 patient deaths averted and $28 billion in savings. While HACs include many different ailments, hospitals usually focus their prevention efforts on hospital-acquired infections (HAIs) because they can prove deadly and form the bulk of a hospital’s HAC score, which CMS uses to calculate reimbursement penalties under its HAC Reduction Program. Based on nearly three years of data from CMS and Definitive Healthcare, a review shows that despite some improvements, hospitals still have difficulty reducing infections and their progress appears slow.
In order to properly compare infection rates across hospitals, CMS uses a figure called the standardized infection ratio (SIR). The SIR adjusts for a hospital’s patient population, historical health indicators, and other factors outside a facility’s control that may make patients more or less likely to develop an infection. For any given year, a hospital receives an estimate of the expected HAIs it will encounter as a benchmark. The actual number of observed HAIs for the year is divided by this figure and the end result is the SIR (a figure below one is better).
Average Hospital Standard Infection Ratios (SIRs), 2013-2015
Source: CMS and Definitive Healthcare
As shown above, the average hospital has consistently kept its SIR below one for all HAC Reduction Program infections with the exception of catheter-associated urinary tract infections, which had a dramatic improvement between 2014 and 2015. The rapid decline can be attributed to the fact that data for FY 2015 has over 400 additional data points (fewer hospitals’ CAUTI SIR data was listed as “Not Available”), and the number of facilities that reported zero CAUTIs nearly doubled from previous years, bringing down the overall average. In addition, hospitals have generally struggled to reduce CAUTIs over the past several years, despite a strong push from CMS beginning in 2008 to reduce rates. A recent study involving 603 hospitals suggested that it is possible to better prevent CAUTIs by ensuring only patients that need a catheter actually receive one and that staff have proper infection management and prevention training.
While the graph shows a slight increase in SIR for many infections, the rise does not necessarily reflect real growth in the infection rate, given that the predicted infection rate for hospitals can vary each year. For instance, while the average MRSA SIR for 2015 shows an overall increase since 2013, the median predicted number of annual cases declined from 1.19 to 1.14 during the same period, as seen in the graph below. It appears to be a small change, but the difference can accumulate given the thousands of hospitals involved and the fact that a single case can dramatically affect a facility’s score, depending on the infection type and the size of the hospital. The same is true for CLABSIs. In reality, the total number of MRSA infections and CLABSIs has decreased by 13 percent from 2011 to 2014 and 50 percent from 2008 and 2014, respectively, according to the CDC.
Median Predicted Infection Cases, 2013-2015*
*C Diff excluded to preserve scale
HAIs are set to become an even greater component of CMS’ HAC Reduction Program next year, as SIRs for MRSA and C Diff will be included in the reimbursement calculation. Overall rates for MRSA have fallen recently, but C Diff has become a growing threat and could pose a problem for facilities that already struggle to control infections currently measured in the program. Given existing trends infection control will remain a high-priority part of hospitals’ overall quality strategy well into the future.
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