What’s New in the Patient Safety World
January 2016
HAC’s Have Declined Since 2010
In our February
2015 What's New in the Patient Safety World column “17%
Fewer HAC’s: Progress or Propaganda?” we discussed the preliminary data
from AHRQ which showed that there was a 17% reduction in hospital-acquired
conditions (HAC’s) in the previous 3 years, saving 50,000 lives and $12 billion
(AHRQ
2014). The improvement was largely attributed to government-sponsored
programs. Our “hype radar” immediately went into high gear. However, after
assessing the data and some corroborative data from other sources, we conceded
this was one instance where our “hype radar” was wrong and that this truly was
progress.
AHRQ has now
released its interim data for 2010 to 2014 (AHRQ
2015). The measured interim rate for 2014 held steady from 2013 at 121 HACs
per 1,000 discharges, down from 145 in 2010. That is a 17% decline in the HAC
rate over the four year period. They estimate that nearly 87,000 fewer patients
died in the hospital as a result of the reduction in HACs and that
approximately $19.8 billion in health care costs were saved from 2010 to 2014.
The news was heralded by a press release from HHS (HHS
2015) attributing the improvement to the Accountable Care Act, CMS
financial incentive and penalty programs, widespread adoption of electronic
medical records, the Partnership for Patients program, and HENS (Hospital
Engagement Networks), among others.
Some have noted a
“positive spin” in the most recent report since, in reality, HAC’s remained at
the same level in 2014 that they were at in 2013. That is after the rather
steep decline the previous three years. The good news is that the HAC rate for
2014 did not increase, as it might if the previous “progress” were really just
a statistical fluke. But does the plateau mean we’ve hit a barrier? The AHRQ
report admits that the HAC rate is still too high and we need to continue to do
more to avoid these conditions.
Over the 4-year
period the biggest reductions in HAC’s percentage-wise were seen for CLABSI’s
(-72%), CAUTI’s (-38%), and post-op venous thromboembolism (-43%). But the
greatest financial savings came from reductions in pressure ulcers and adverse
drug events ($6.5B of the total $7.8B savings came from just these 2 categories).
And of the estimated 36,295 avoided deaths, 22,444 came from reduction in
pressure ulcers.
We’re not surprised
at the success in reducing CLABSI’s and CAUTI’s given the substantial
evidence-based preventive interventions that have now been widely adopted for
several years. But we are, frankly, surprised at the magnitude of the reduction
(-23%) in pressure ulcers.
So, of course, we
would look to see if there is other evidence corroborating this significant
improvement in prevention of pressure ulcers. And, in fact, we find it in data
accumulated in the PA-PSRS (Pennsylvania Patient Safety Reporting System)
database and reported by the PPSA (Pennsylvania Patient Safety Authority). That
report (Feil
2015) confirms a substantial reduction in hospital-acquired pressure
ulcers from 2011 to 2013. Feil and Bisbee describe
the Pennsylvania Hospital Engagement Network (PA-HEN) Pressure Ulcer Prevention
(PUP) project that achieved a 62.7% reduction in the incidence rate of stage
III and IV hospital-acquired pressure ulcers in Medicare patients. That PPSA
report has links to the PUP project site and to the evidence-based pressure
ulcer prevention guidelines from multiple quality and patient safety
organizations. You’ll find that article to be very useful.
References:
AHRQ. Interim
Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost
Savings and Deaths Averted From 2010 to 2013. AHRQ Partnership for Patients
2014
http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2013.pdf
AHRQ (Agency for
Healthcare Research and Quality). Saving Lives and Saving Money:
Hospital-Acquired Conditions Update. Interim Data from National Efforts To Make Care Safer, 2010-2014. AHRQ 2015
http://www.ahrq.gov/sites/default/files/publications/files/interimhacrate2014_2.pdf
HHS (Health and
Human Services). National patient safety efforts save 87,000 lives and nearly
$20 billion in costs. Press release December 1, 2015
http://www.hhs.gov/about/news/2015/12/01/national-patient-safety-efforts-save-lives-and-costs.html
Feil M, Bisbee J. Hospital-Acquired Pressure
Ulcers Remain a Top Concern for Hospitals. Pa Patient Saf
Advis 2015; 12(1): 28-36
http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2015/mar;12%281%29/Pages/28.aspx
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