Medpage offers recently:


 

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 director Richard 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.


If all these things were the scientific and natural result of the improvements cited – the EMR, the partnership, the medicare payment system – why do we even have to bother identifying problems, as they all will be automatically swept up and fixed in the same net?

And what of the stubborn problem of evolution – you produce what you select for.  Are the responses truly beneficial, or are they just the result of trimming carefully around the boundaries.

Take out central lines, take out bladder catheters.  That’s easy to order.  Make the justification for them so onerous that nobody will use them.  That’s easy.  Straight-cath every 12 hours when no urine output.  Code for bladder outlet obstruction and treat THAT, rather than preventing it by placing bladder catheters.

Are the responses producing better care?  Who knows?  And who will tell, if they know?

 

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