AHRQ Analysis: Hospital-Acquired Conditions Reduced by 17 Percent From 2010 to 2013

Hospital patient safety substantially improved from 2010 to 2013 with a 17 percent decline in hospital-acquired conditions (HACs), according to a final data synthesis from AHRQ. The decline translates to 1.3 million fewer incidents of patient harm, approximately 50,000 fewer patient deaths in hospitals and $12 billion in health care cost savings. Gains were particularly strong in 2013 when 800,000 fewer patients experienced harms, 35,000 fewer patients died and $8 billion in unnecessary costs was saved compared with 2010. HACs include adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, pressure ulcers and surgical site infections, and several other types of adverse events. While precise reasons for the HAC decline cannot be pinpointed, it coincided with concerted efforts among hospitals across the country to reduce adverse events. Efforts were spurred by the Affordable Care Act, which created Medicare payment incentives to improve the quality of care and by HHS’ Partnership for Patients initiative. Many hospitals have used tools and resources developed by AHRQ – including the Comprehensive Unit-based Safety Program, the Re-Engineered Discharge Toolkit and TeamSTEPPS® – to improve care. AHRQ Director Richard Kronick, Ph.D., discussed these improvements in hospital care in his recent blog post.

U.S. Hospital-Acquired Conditions Drop by 17 Percent Over Three Years: Progress Made; Work Remains | Agency for Healthcare Research & Quality

AHRQ Views

Blog posts from Richard Kronick, Ph.D., and other AHRQ leaders

OCT

2015

U.S. Hospital-Acquired Conditions Drop by 17 Percent Over Three Years: Progress Made; Work Remains

By Richard Kronick Ph.D.

Making care safer is an easy goal to support — no one wants to be harmed by the care they receive and no provider wants to cause harm. But reaching that goal is not as simple as it sounds. That’s why the final results from nationwide efforts to lower the rate of hospital-acquired conditions (HACs) are especially welcome.

HACs are costly and dangerous events that occur while patients are receiving care for another condition during a hospital stay. HACs may include bloodstream and urinary tract infections, pressure ulcers, and adverse drug events. New data that are part of a national scorecard from the Agency for Healthcare Research and Quality (AHRQ) show that between 2010 and 2013, the rate of HACs declined by 17 percent around the country, saving about 50,000 lives and nearly $12 billion in health costs. The final report concludes that hospital patients experienced 1.3 million fewer HACs over the 3-year period than would have occurred had the rates remained at the 2010 level.

These results come at a time of sustained and coordinated attention to lowering HACs spurred by the Affordable Care Act. Participating Federal health agencies include the Centers for Medicare & Medicaid Services (CMS), AHRQ, and the Centers for Disease Control and Prevention. Beginning in 2011, CMS led a public-private quality improvement effort known as the Partnership for Patients (PfP), which engaged 80 percent of the nation’s acute-care hospitals in strategies to lower HAC rates. At the outset of the PfP initiative, AHRQ helped coordinate the development and use of a national measurement strategy, the results of which are known as the “AHRQ National Scorecard.” It provides summary data on the national HAC rate.

Although the Scorecard came about as a result of the PfP, it reflects national improvement that’s attributable to many factors. Other Federal contributors to this outcome include Medicare payment policies, the availability of and effective use of electronic health records, public reporting of hospital-level HAC results to Hospital Compare and technical assistance from CMS’ Quality Improvement Organizations. All these factors served to spur hospitals and providers to engage, learn best practices, and report and get feedback — all in a timely manner.

AHRQ’s final report shows that gains were especially strong in 2013. Data from that year alone account for nearly half of the total HAC reductions (9 percent) and more than half of the estimated lives saved (35,000) and costs averted ($8 billion). Declines in the rates of pressure ulcers and adverse drug events are responsible for the largest proportion of lives saved and averted costs, the report says.

In addition to the measurement strategy, much of the improvement activity work that took place in hospitals to achieve these results was based on or grew out of AHRQ-funded research. The progress underscores the Agency’s core activities: funding evidence-based research, producing tools and training materials that catalyze change, and investing in data and measures. Some of the more popular AHRQ tools that U.S. hospitals participating in the PfP have been using include the Comprehensive Unit-based Safety Program, AHRQ’s teamwork training program known asTeamSTEPPS®, the Guide to Patient and Family Engagement in Hospital Quality and Safety, and surveys to help staff in a variety of health care settings evaluate their patient safety culture.

The 17 percent drop in HACs is a cause for optimism, and everyone who worked to make patients safer from these conditions deserves credit. But more work remains. The 2013 HAC rate of 121 HACs per 1,000 hospital inpatients, although down from 145 in 2010, is still too high. That rate — and the harm and costs that it conveys — are unacceptable.

Based on the HACs that we continue to measure and the demonstrated success since 2010, we are convinced that further reductions are both necessary and possible. Our goal of making the U.S. health care system as safe as possible is not yet in sight, but is closer now than before.

Page last reviewed October 2015

Internet Citation: U.S. Hospital-Acquired Conditions Drop by 17 Percent Over Three Years: Progress Made; Work Remains. October 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/blog/ahrqviews/100915.html