부산대학교 도서관

Background: Beginning in 2008, the Centers for Medicare and Medicaid Services implemented a series of payment policies and programs aimed at reducing hospital acquired conditions (HAC) that were deemed preventable. These included ceasing additional payments for HACs that were not present on admission (POA), Partnership for Patients (a collaborative engagement and improvement program), and the HAC Reduction Program which imposes financial penalties on hospitals with the worst HAC rates. Surgical Site Infection-Mediastinitis after CABG (HAC 08) has been targeted by all three of these policies. Objective: To evaluate the incremental consequences of a specific inpatient adverse outcome, HAC 08, in terms of mortality, length of stay (LOS), and total hospital cost per case using all-payer data from acute-care hospitals in the US. Methodology and data sources: The CMS HAC 08 denominator included all patients who met the HAC definition of CABG, while the numerator was the members of this CABG group who had the HAC 08 adverse outcome. The FFY 2016 Truven Projected Inpatient Data Base (PIDB) containing approximately 20 million discharges per year from more than 2,600 acute-care hospitals was used for this analysis. Only POA diagnosis codes were used to set risk adjustment categories (excludes complications) and only non-POA codes were used to identify HAC. Data were adjusted for age, sex, admission source and type, case-mix, and co-morbid conditions using ICD-10 diagnosis and procedure codes. Statistical models were used to calculate mortality, LOS, and total hospital costs. Results: Among over 20 million discharges from 5,070 hospitals, there were 117,605 CABG procedures with 43 HAC 08 adverse outcomes resulting in a raw rate of 3.8 adverse outcomes per 10,000 CABGs performed. Per patient adjusted excess length of stay was 18.5 days (p<0.0001). Per patient adjusted excess total hospital costs were $135,600 (p<0.0001). Increased adjusted risk of death was 913% (OR: 10.13, 95% CI: 4.86-21.14, p<0.0001). Conclusion: Almost a decade after implementation of multiple strategies for HAC reduction, the rates of mediastinitis after CABG are still significant. Furthermore, the consequences of this preventable adverse outcome are severe, resulting in substantial excess death, days of stay, and costs of care. [ABSTRACT FROM AUTHOR]