HHS Public Access Author manuscript Author Manuscript
Med Care. Author manuscript; available in PMC 2017 May 01. Published in final edited form as: Med Care. 2016 May ; 54(5): 512–518. doi:10.1097/MLR.0000000000000516.
Are Evidence-based Practices Associated with Effective Prevention of Hospital-acquired Pressure Ulcers in U.S. Academic Medical Centers?
Author Manuscript
William V. Padula, PhD, MS, MSc, Assistant Professor, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Robert D. Gibbons, PhD, Professor, Department of Public Health Sciences, University of Chicago, Chicago, IL Robert J. Valuck, PhD, RPh, Professor, Department of Clinical Pharmacy, University of Colorado, Aurora, CO Mary Beth F. Makic, PhD, RN, Associate Professor, College of Nursing, University of Colorado, Aurora, CO Manish K. Mishra, MD, MPH, Assistant Professor, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
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Peter J. Pronovost, MD, PhD, FCCM, and Professor, Departments of Anesthesiology, Critical Care and Surgery, Johns Hopkins School of Medicine, Baltimore, MD David O. Meltzer, MD, PhD Professor, Department of Medicine, University of Chicago, Chicago, IL William V. Padula: [email protected]; Robert D. Gibbons: [email protected]; Robert J. Valuck: [email protected]; Mary Beth F. Makic: [email protected]; Manish K. Mishra: [email protected]; Peter J. Pronovost: [email protected]; David O. Meltzer: [email protected]
Abstract
Author Manuscript
Background—In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. Objective—To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. Methods—We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 UHC
CORRESPONDENCE: Dr. William Padula, Department of Health Policy & Management, 624 N. Broadway Ave., Baltimore, MD 21205; [email protected].
Padula et al.
Page 2
Author Manuscript
hospitals between 2007–2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding and QI on HAPU rates. The models assumed level-2 randomintercepts and random effects for CMS policy and EBP implementation to account for betweenhospital variability in HAPU incidence. Results—Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (−1.86 cases/quarter; p=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (−11.32 cases/quarter; p
Med Care. Author manuscript; available in PMC 2017 May 01. Published in final edited form as: Med Care. 2016 May ; 54(5): 512–518. doi:10.1097/MLR.0000000000000516.
Are Evidence-based Practices Associated with Effective Prevention of Hospital-acquired Pressure Ulcers in U.S. Academic Medical Centers?
Author Manuscript
William V. Padula, PhD, MS, MSc, Assistant Professor, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Robert D. Gibbons, PhD, Professor, Department of Public Health Sciences, University of Chicago, Chicago, IL Robert J. Valuck, PhD, RPh, Professor, Department of Clinical Pharmacy, University of Colorado, Aurora, CO Mary Beth F. Makic, PhD, RN, Associate Professor, College of Nursing, University of Colorado, Aurora, CO Manish K. Mishra, MD, MPH, Assistant Professor, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
Author Manuscript
Peter J. Pronovost, MD, PhD, FCCM, and Professor, Departments of Anesthesiology, Critical Care and Surgery, Johns Hopkins School of Medicine, Baltimore, MD David O. Meltzer, MD, PhD Professor, Department of Medicine, University of Chicago, Chicago, IL William V. Padula: [email protected]; Robert D. Gibbons: [email protected]; Robert J. Valuck: [email protected]; Mary Beth F. Makic: [email protected]; Manish K. Mishra: [email protected]; Peter J. Pronovost: [email protected]; David O. Meltzer: [email protected]
Abstract
Author Manuscript
Background—In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. Objective—To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. Methods—We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 UHC
CORRESPONDENCE: Dr. William Padula, Department of Health Policy & Management, 624 N. Broadway Ave., Baltimore, MD 21205; [email protected].
Padula et al.
Page 2
Author Manuscript
hospitals between 2007–2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding and QI on HAPU rates. The models assumed level-2 randomintercepts and random effects for CMS policy and EBP implementation to account for betweenhospital variability in HAPU incidence. Results—Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (−1.86 cases/quarter; p=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (−11.32 cases/quarter; p
