title: Quality Improvement Initiatives Need Rigorous Evaluation: The Case of Pressure Ulcers.
abstract: The Partnership for Patients (PfP) and the Agency for Healthcare Research and Quality (AHRQ) have reported a 23.5% decline in hospital-acquired pressure ulcers (HAPU) over 4 years resulting in a cumulative cost savings of more than $10 billion and 49 000 averted deaths, claiming that this significant decline may have been spurred in part by Medicare payment incentives associated with severe (stage 3 or 4) HAPUs. Hospitals with a high rate of severe HAPUs have a payment penalty imposed, creating a financial disincentive to report severe HAPUs, possibly contributing to the magnitude of the reported decline. Despite the financial disincentive to report, the number of severe HAPUs found in claims data over the corresponding 4-year period did not decline but instead remained unchanged. The results from claims data, combined with some flaws in estimating HAPUs, call into question the validity of the decline in HAPUs reported by PfP and AHRQ.
authors: 1 3M Health Information Systems, Wallingford, CT.
authors: Richard F
authors: RF
authors: Averill
authors: 2 Yale University School of Medicine, New Haven, CT.
authors: John S
authors: JS
authors: Hughes
authors: 1 3M Health Information Systems, Wallingford, CT.
authors: Richard L
authors: RL
authors: Fuller
authors: 1 3M Health Information Systems, Wallingford, CT.
authors: Norbert I
authors: NI
authors: Goldfield
mesh_terms: D017046:Cost Savings; D006801:Humans; D006278:Medicare / Q000458:organization & administration; D003668:Pressure Ulcer / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards*; D012052:Reimbursement, Incentive; D014481:United States / Q000453:epidemiology
keywords: Partnership for Patients; hospital-acquired complications; pressure ulcers; quality measurement