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Some good news from the US Department of Health and Human Services this week: Instances of patient harm in hospitals decreased 9% between 2010 and 2012, while Medicare fee-for-service 30-day readmissions dropped 8%.
Hospital-acquired conditions went from 145 per 1,000 discharges in 2010 to 132 per 1,000 discharges in 2012. All-cause Medicare 30-day readmissions dropped to 17.5% in 2013, a full percentage point from 2012, resulting in about 150,000 fewer readmissions. There were also declines in ventilator-associated pneumonia (53.2%), falls and trauma (14.7%), obstetric trauma (15.8%), venous thromboembolic complications (12.9%), and pressure ulcers (25.2%).
HHS, of course, attributes the new numbers to initiatives created by the Affordable Care Act. Medicare is financially penalizing hospitals with high infection and 30-day readmission rates. The numbers seem to reflect that the stick approach to quality improvement is working, though it’s only an assumption at this point. There is some speculation that declining harm and readmission rates are partly due to the recent proliferation of hospital safety rankings and quality scorecards. HHS also praises its public-private partnerships and hospital engagement networks for working together to reduce harm.
It’s difficult to say whether any one factor had more of an effect than others on the declining rates. Increased scrutiny on quality improvement initiatives from hospital safety ranking systems and CMS penalties certainly factor in, but to what extent? Hopefully the next study will get more in depth in asking hospitals about the biggest quality improvement driver.