HHS: Dramatic Downturn in Hospital-Acquired Conditions
Big reductions in adverse drug events, pressure ulcers
WASHINGTON -- The rate of hospital-acquired conditions (HACs) has dropped by 17% over a 4-year period, the Department of Health and Human Services (HHS) reported Tuesday.
The rate of HACs dropped from 145 per 1,000 discharges in 2010 to 121 per 1,000 discharges in 2014, according to the report, which was issued by the Agency for Healthcare Research and Quality (AHRQ).
Over a 4-year period starting in 2011, "a cumulative total of 2.1 million fewer HACs were experienced by hospital patients ... relative to the number of HACs that would have occurred if rates had remained steady at the 2010 level," the report noted. "Approximately 87,000 fewer patients died in the hospital as a result of the reduction in HACs, and approximately $19.8 billion in health care costs were saved from 2010 to 2014."
"These results represent real people who did not die or suffer infections or harm in the hospital," said Patrick Conway, MD, chief medical officer at the Centers for Medicare and Medicaid Services (CMS), in a conference call with reporters. "The data continue to show ... that we are on our way to achieving the results in improving the quality of care in the hospital setting while investing our health dollars more wisely."
The report's numbers come from a tally of 28 different HAC measures reported by more than 3,000 hospitals. Some of the biggest reductions were in three of most four frequent types of HACs, noted AHRQ directorRichard Kronick, PhD, who was also on the conference call: adverse drug events (accounting for 40% of the total reductions in HACs), pressure ulcers (28%), and catheter-associated urinary tract infections (CAUTIs, 16%).
"Overall, hospital-acquired infections showed reductions -- most notably, in central line-associated bloodstream infections (CLABSIs), which are relatively rare but quite deadly," he said. "In 2010, [the rate] was 0.55 per 1,000 hospitalizations, but by 2014, that was reduced to 0.15 per 1,000. We're clearly not yet at zero, but getting close."
Several factors account for the decreases, Kronick said, "for example, the widespread implementation and improved use of electronic health records at hospitals, the Partnership for Patients effort was launched ... and Medicare payment reforms were implemented."
"Progress was also made possible by investments made by AHRQ in ... producing evidence about how to make care safer, investing in tools and training to catalyze improvement, and investing in data and measures to be able to track change," he said.
The news was not all good, however; for instance, the rate of HACs did not change between 2013 and 2014, remaining at 121 per 1,000 (the rate for 2014 was called an "interim" rate). As to why the rate leveled off, "we don't have a full answer to that question," Kronick said . "Likely the dramatic improvements in the earlier years were ... the relatively lower-hanging fruit, and hospitals are now working on more difficult problems."
In addition, "Some of this is a timing issue," he continued. "We adopted in 2014 the National Action Plan for Adverse Drug Events ... It will take some time before we see the results of that, similarly [with the] recent adoption of National Action Plan for Combatting Antibiotic-Resistant Bacteria."
The number of falls was another problem area -- it remained at 260,000 in 2014, the same as in 2010. "Falls are a double-edged sword," Kronick said. "What's important for many patients is getting them up and about and having them moving more, which increases exposure to falls ... A reasonable hypothesis is that more patients are moving more and that's a good thing, but it increases exposure to falls."
But overall, the officials were pleased with the results. "As a practicing physician in the hospital setting, this work in improving patient safety is one of, if not the most important, thing we could do for patients," said Conway. "Patients want to avoid infections and adverse harm events, and we need to have health system that's as safe as possible for all patients."
Kronick agreed. "Having been involved in this business for much longer than I care to remember ... To see the progress here -- 87,000 fewer people dying over the last 4 years than would have died if the 2010 rates remained in place -- is very heartwarming for me."
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