付费机制与医院感染预防的循证证据

蓝鱼o_0

美国在2008年调整了付费机制，并更名将nosocomial infections改为healthcare associated infections（详情请见胡教授的PPT）那么付费机制的改变，有什么样的效果呢？
宏观流行病学调查发现，通过付费机制的改变，IPs对HAIS的关注显著增加。这个比例是多少81%！！
CMS policy led to increased attention to HAI prevention

• May 3, 2012
  

Results of a national survey that assessed the effect of the 2008 CMS policy to adjust payment for health care-associated infections indicated that 81% of infection preventionists reported increased attention to health care-associated infections targeted by the policy.
In December 2010, researchers sent a survey to a random sample of US acute care hospitals affected by the CMS inpatient prospective payment system (n=317). The duration of experience among survey participants varied: 45% reported working in the infection control field for more than 10 years, whereas 31% reported working in the field for 5 years or less.
Although 19% reported that they participated in pay-for-performance programs aimed at reducing health care-associated infections (HAIs) via private insurers, 85% stated that their institution supported local, regional and national efforts to decrease HAIs.
Seventy-seven percent reported stable funding for infection control associated with the CMS policy vs. 15% of those who reported increased funding. As a result of the policy, faster removal of central venous (50%) and urinary catheters (71%) were reported. Conversely, routine urine (27%) and blood testing (13%) upon hospital admission occurred less frequently.
Larger hospitals appeared to spend less time on nontargeted HAIs (OR=2.3; 95% CI, 1-5.1) when compared with hospitals with front-line staff who were receptive to change (OR=0.5; 95% CI, 0.3-0.8).
“Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy,” the researchers wrote. “Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear.”

References:

• Lee GM. Am J Infect Control. 2012;40:314-319.
  

Disclosures:

• The researchers report no relevant financial disclosures.
  

gemao

CMS政策增加HAI预防的关注

一项针对2008年调整医疗相关感染付费的CMS政策的全国性的调查结果显示：81%的感染预防人员认为此项政策使得医院内感染的关注度增加。

2010年12月，研究者向随机选择的受CMS政策影响美国医院（n=317）发放调查表，参与调查人员的工作经验不同，45%从事感染控制专业超过10年，31%在此专业工作不足5年。

尽管19%的医院报告他们通过私人保险公司参加针对减少医院感染的付费项目，85%的医院声明他们的机构受当地、地区和国家鼓励支持降低HAIs。77%的医院报告有稳定的经费用于控制CMS政策相关的感染，其中15%报告经费增加。这项政策的结果，50%的中央静脉导管和71%的导尿管被快速去除，相反，在入院期时的常规尿液检查（27%）和血液检查（13%）减少。与一线工作人员乐于接受改变的医院相比(OR=0.5; 95% CI, 0.3-0.8)，大医院在花非目标性HAI上的时间减少(OR=2.3; 95% CI, 1-5.1)。感染控制人员报告较大医院关注预防目标性HAI是CMS不支付政策的结果，在HAI预防方面增加关注和更多的承诺能否改善病人的结局尚不明了。