新英格兰杂志——美国医院不支付对预防感染的影响
N Engl J Med. 2012 Oct 11;367(15):1428-37. doi: 10.1056/NEJMsa1202419.Effect of nonpayment for preventable infections in U.S. hospitals.Lee GM, Kleinman K, Soumerai SB, Tse A, Cole D, Fridkin SK, Horan T, Platt R, Gay C, Kassler W, Goldmann DA, Jernigan J, Jha AK.
SourceCenter for Child Health Care Studies, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA. grace.lee@childrens.harvard.edu
AbstractBACKGROUND:In October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued additional payments for certain hospital-acquired conditions that were deemed preventable. The effect of this policy on rates of health care-associated infections is unknown.METHODS:Using a quasi-experimental design with interrupted time series with comparison series, we examined changes in trends of two health care-associated infections that were targeted by the CMS policy (central catheter-associated bloodstream infections and catheter-associated urinary tract infections) as compared with an outcome that was not targeted by the policy (ventilator-associated pneumonia). Hospitals participating in the National Healthcare Safety Network and reporting data on at least one health care-associated infection before the onset of the policy were eligible to participate. Data from January 2006 through March 2011 were included. We used regression models to measure the effect of the policy on changes in infection rates, adjusting for baseline trends.RESULTS:A total of 398 hospitals or health systems contributed 14,817 to 28,339 hospital unit-months, depending on the type of infection. We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented. There were no significant changes in quarterly rates of central catheter-associated bloodstream infections (incidence-rate ratio in the postimplementation vs. preimplementation period, 1.00; P=0.97), catheter-associated urinary tract infections (incidence-rate ratio, 1.03; P=0.08), or ventilator-associated pneumonia (incidence-rate ratio, 0.99; P=0.52) after the policy implementation. Our findings did not differ for hospitals in states without mandatory reporting, nor did it differ according to the quartile of percentage of Medicare admissions or hospital size, type of ownership, or teaching status.CONCLUSIONS:We found no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals. (Funded by the Agency for Healthcare Research and Quality.).
背景 （美国）医疗保险和医疗补助服务中心（CMS）于2008年10月停止对某些被认定为可预防的医院获得性感染的额外支付。这项政策对医疗保健相关感染率的影响尚不清楚。
方法 我们用一种含有比较系列的间断时间系列准实验设计来研究CMS政策针对的2种医疗保健相关感染（中心导管相关血流感染和导尿管相关尿路感染）与政策非针对的一项转归（呼吸机相关肺炎）相比较的趋势变化。参与（美国）国家医疗保健安全性网络并且在政策开始（实施）之前报告了至少1种医疗保健相关感染的医院有参与资格。研究包括了自2006年1月至2011年3月的数据。我们用回归模型来检测该政策对感染率变化的影响，并且调整了基线趋势。
结果 根据感染的类型，共398家医院或卫生系统贡献了14817～28339医院单元-月。我们观察到早在政策实施之前，政策针对的感染和政策非针对的感染均有长期降低趋势。在政策实施之后，中心导管相关血流感染（实施之后与实施之前的发生率比为1.00，P＝0.97）、导尿管相关尿路感染（发生率比1.03，P＝0.08）或通气机相关肺炎（发生率比0.99，P＝0.52）的季度发生率均无显著变化。我们的结果没有因无强制报告的各州医院而异，也没有随医疗保险住院百分率的四分位数或医院规模、所有制类型或教学情况而异。
结论 我们没有发现2008年CMS政策（减少对中心导管相关血流感染和导尿管相关尿路感染的支付）对美国医院感染率有任何可检测到的影响证据。 全文下载
http://www.nejm.org/doi/pdf/10.1056/NEJMsa1202419
樵夫 发表于 2013-7-15 21:16 static/image/common/back.gif
全文下载
http://www.nejm.org/doi/pdf/10.1056/NEJMsa1202419
没有明显的影响，但绝对能提高感控水准。 樵夫 发表于 2013-7-15 21:15 static/image/common/back.gif
背景 （美国）医疗保险和医疗补助服务中心（CMS）于2008年10月停止对某些被认定为可预防的医院获得性感染的 ...
在这次APSIC会议上面，我写了专门的评论关于NON-PAYMENT。
尽管目前研究尚无显著性作用，但是这个政策带来对全球感控的影响着实巨大。
个人体会不能从简单的结论来看这个问题。 蓝鱼o_0 发表于 2013-7-15 21:34 static/image/common/back.gif
在这次APSIC会议上面，我写了专门的评论关于NON-PAYMENT。
尽管目前研究尚无显著性作用，但是这个政策 ...
有些医院感染的发生，并不是一个政策就能改变的。控制医院感染，牵涉到许多技术性的因素。责任心只是其中的一部分。还有许多控制技术的基础理论研究有待深化。加大感控学科的基础研究势在必行，而这往往又是我们经常所忽视的问题,郁闷中... 鬼才 发表于 2013-7-15 21:49 static/image/common/back.gif
有些医院感染的发生，并不是一个政策就能改变的。控制医院感染，牵涉到许多技术性的因素。责任心只是其中 ...
学科发展不是捉急就有用的，况且还有“大家”们，如胡教授，李教授们。这是他们思考的问题{:1_9:}咱操神马心啊。 樵夫 发表于 2013-7-15 21:16 static/image/common/back.gif
全文下载
http://www.nejm.org/doi/pdf/10.1056/NEJMsa1202419
哈哈，你发过了啊，没有搜索到呢？那你合并一下啦 "我们观察到早在政策实施之前，政策针对的感染和政策非针对的感染均有长期降低趋势。"在美国停止额外支付应是水到渠成的事情.
我们还有很长的路要走. 医保支付对感染率没有什么直接的影响，看来感染是系统问题
页:
[1]