ArticleBMJ (Clinical research ed.)2019
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
Article in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed.
- A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line-Associated Bloodstream Infections, and Surgical Site Infections.Mayo Clinic proceedings. Innovations, quality & outcomes · 2025Review
- Use of central venous access devices outside of the pediatric intensive care units.Pediatric research · 2025Article
- Article
- What works to reduce socioeconomic inequalities in hospitalisations and readmissions? Systematic review of the equity impacts of population-level, health service and integrative interventions.BMJ public health · 2025Article
- Association Between Socioeconomic Disadvantage and Risks of Early and Recurrent Admissions Among Patients With Newly Diagnosed Heart Failure.Circulation. Cardiovascular quality and outcomes · 2024Article
- Do Decision Support Tools Decrease the Prevalence of Hospital-Acquired Venous Thromboembolisms When Compared to Clinical Judgement? A Single-Center Pre-Post Study.Journal of clinical medicine · 2024Article
- Teaching and Safety-Net Hospital Penalization in the Hospital-Acquired Condition Reduction Program.JAMA network open · 2024Article
- Reportable infections following colon surgery in a large public healthcare system in New York City: The consequences of being a level 1 trauma center.Infection control and hospital epidemiology · 2024Article
- Evaluating the Effect of Financial Penalty on Hospital-Acquired Infections.Risk management and healthcare policy · 2024Article
- THE ROLE OF HEALTH POLICY IN IMPROVING HEALTH OUTCOMES AND HEALTH EQUITY.Transactions of the American Clinical and Climatological Association · 2024Article
- Concerns and frustrations about the public reporting of device-related healthcare-associated infections: Perspectives of hospital leaders and staff.American journal of infection control · 2023Article
- Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States.PloS one · 2023Article
- Measuring the State Dependence Effect in Hospital Payment Adjustment.International journal of environmental research and public health · 2022Article
- Combined impact of Medicare's hospital pay for performance programs on quality and safety outcomes is mixed.BMC health services research · 2022Article
- Association of the Medicare Value-Based Purchasing Program With Changes in Patient Care Experience at Safety-net vs Non-Safety-net Hospitals.JAMA health forum · 2022Article
- High-Performing and Low-Performing Hospitals Across Medicare Value-Based Payment Programs.JAMA health forum · 2022Article
- Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia.Journal of general internal medicine · 2022Article
- Hospital-Acquired Condition Rate of Admitting Facility Does Not Predict Mortality in Traumatically Injured Patients.Cureus · 2022Article
- Hospital value-based payment programs and disparity in the United States: A review of current evidence and future perspectives.Frontiers in public health · 2022Review
- Assessment of Costs and Care Quality Associated With Major Surgical Procedures After Implementation of Maryland's Capitated Budget Model.JAMA network open · 2021Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveTo evaluate the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and subsequent changes in clinical outcomes.
designRegression discontinuity design applied to a retrospective cohort from inpatient Medicare claims.
setting3238 acute care hospitals in the United States.
participantsMedicare fee-for-service beneficiaries discharged from acute care hospitals between 23 July 2014 and 30 November 2016 and eligible for at least one targeted hospital acquired condition (n=15 470 334).
interventionHospital receipt of a penalty in the first year of the HACRP.
main outcome measuresEpisode level count of targeted hospital acquired conditions per 1000 episodes, 30 day readmissions, and 30 day mortality.
resultsOf 724 hospitals penalized under the HACRP in fiscal year 2015, 708 were represented in the study. Mean counts of hospital acquired conditions were 2.72 per 1000 episodes for penalized hospitals and 2.06 per 1000 episodes for non-penalized hospitals; 30 day readmissions were 14.4% and 14.0%, respectively, and 30 day mortality was 9.0% for both hospital groups. Penalized hospitals were more likely to be large, teaching institutions, and have a greater share of patients with low socioeconomic status than non-penalized hospitals. HACRP penalties were associated with a non-significant change of -0.16 hospital acquired conditions per 1000 episodes (95% confidence interval -0.53 to 0.20), -0.36 percentage points in 30 day readmission (-1.06 to 0.33), and -0.04 percentage points in 30 day mortality (-0.59 to 0.52). No clear patterns of clinical improvement were observed across hospital characteristics.
conclusionsPenalization was not associated with significant changes in rates of hospital acquired conditions, 30 day readmission, or 30 day mortality, and does not appear to drive meaningful clinical improvements. By disproportionately penalizing hospitals caring for more disadvantaged patients, the HACRP could exacerbate inequities in care.
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