title: Initial impact of Medicare's nonpayment policy on catheter-associated urinary tract infections by hospital characteristics.
abstract: OBJECTIVE
  The goal of this study was to evaluate the trend in urinary tract infections (UTIs) from 2005 to 2009 and determine the initial impact of Medicare's nonpayment policy on the rate of UTIs in acute care hospitals.
  
  
  BACKGROUND
  October 2008 commenced Medicare's nonpayment policy for the additional care required as a result of hospital-acquired conditions, including catheter-associated urinary tract infections (CAUTIs). CAUTIs are the most common form of hospital-acquired infections.
  
  
  METHODS
  Rates of CAUTIs were analyzed by patient and hospital characteristics at the hospital level on a quarterly basis, yielding 20 observation points. October 2008 was used as the intervention point. A time series analysis was conducted using the 2005-2009 Nationwide Inpatient Sample datasets. A repeated measures Poisson regression growth curve model was used to analyze the rate of CAUTIs by hospital characteristics.
  
  
  RESULTS
  The annual rate of CAUTIs continues to rise; however the annual rate of change is starting to decline. The change in rate of CAUTIs was not significantly different before and after the policy's payment change. The results of the adjusted time series analysis show that various hospital characteristics were associated with a significant decline in rate of CAUTIs in quarters 16-20 (after the policy implementation) compared to the rate in time 1-15 (before the policy implementation), while other characteristics were associated with a significant increase in CAUTIs.
  
  
  CONCLUSIONS
  Medicare's nonpayment policy was not associated with a reduction in hospitals' CAUTI rates. The use of administrative data, improper coding of CAUTIs at the hospital level, and the short time period post-policy implementation were all limitations in this study.
authors.affiliation: University of North Dakota, 501 N. Columbia Road, Stop 9037, Grand Forks, ND 58202, United States. Electronic address: Kristin.schuller@med.und.edu.
authors.forename: Kristin
authors.initials: K
authors.lastname: Schuller
authors.affiliation: University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, United States. Electronic address: jprobst@mailbox.sc.edu.
authors.forename: Janice
authors.initials: J
authors.lastname: Probst
authors.affiliation: University of South Carolina, 1600 Hampton Street, Suite 507, Room 539, Columbia, SC 29208, United States. Electronic address: jhardin@mailbox.sc.edu.
authors.forename: James
authors.initials: J
authors.lastname: Hardin
authors.affiliation: University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, United States. Electronic address: Kevin.bennett@uscmed.sc.edu.
authors.forename: Kevin
authors.initials: K
authors.lastname: Bennett
authors.affiliation: University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, United States. Electronic address: brocka@mailbox.sc.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Martin
mesh_terms: D055499:Catheter-Related Infections / Q000191:economics* / Q000453:epidemiology; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology; D006291:Health Policy; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000191:economics* / Q000453:epidemiology
keywords: Catheter-associated urinary tract infections; Hospital-acquired infections; Medicare's nonpayment policy; Patient safety; Quality of care