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. 2022 Sep 1;176(9):924-932.
doi: 10.1001/jamapediatrics.2022.2493.

Association Between Hospital-Acquired Harm Outcomes and Membership in a National Patient Safety Collaborative

Maitreya Coffey  1   2   3 , Miguel Marino  4 , Anne Lyren  3   5   6 , David Purcell  7   8 , James M Hoffman  9 , Richard Brilli  10 , Stephen Muething  8 , Daniel Hyman  11   12   13 , Michele Saysana  14   15 , Paul J Sharek  16   17
Affiliations

Association Between Hospital-Acquired Harm Outcomes and Membership in a National Patient Safety Collaborative

Maitreya Coffey et al. JAMA Pediatr. .

Abstract

Importance: Hospital engagement networks supported by the US Centers for Medicare & Medicaid Services Partnership for Patients program have reported significant reductions in hospital-acquired harm, but methodological limitations and lack of peer review have led to persistent questions about the effectiveness of this approach.

Objective: To evaluate associations between membership in Children's Hospitals' Solutions for Patient Safety (SPS), a federally funded hospital engagement network, and hospital-acquired harm using standardized definitions and secular trend adjustment.

Design, setting, and participants: This prospective hospital cohort study included 99 children's hospitals. Using interrupted time series analyses with staggered intervention introduction, immediate and postimplementation changes in hospital-acquired harm rates were analyzed, with adjustment for preexisting secular trends. Outcomes were further evaluated by early-adopting (n = 73) and late-adopting (n = 26) cohorts.

Exposures: Hospitals implemented harm prevention bundles, reported outcomes and bundle compliance using standard definitions to the network monthly, participated in learning events, and implemented a broad safety culture program. Hospitals received regular reports on their comparative performance.

Main outcomes and measures: Outcomes for 8 hospital-acquired conditions were evaluated over 1 year before and 3 years after intervention.

Results: In total, 99 hospitals met the inclusion criteria and were included in the analysis. A total of 73 were considered part of the early-adopting cohort (joined between 2012-2013) and 26 were considered part of the late-adopting cohort (joined between 2014-2016). A total of 42 hospitals were freestanding children's hospitals, and 57 were children's hospitals within hospital or health systems. The implementation of SPS was associated with an improvement in hospital-acquired condition rates in 3 of the 8 conditions after accounting for secular trends. Membership in the SPS was associated with an immediate reduction in central catheter-associated bloodstream infections (coefficient = -0.152; 95% CI, -0.213 to -0.019) and falls of moderate or greater severity (coefficient = -0.331; 95% CI, -0.594 to -0.069). The implementation of the SPS was associated with a reduction in the monthly rate of adverse drug events (coefficient = -0.021; 95% CI, -0.034 to -0.008) in the post-SPS period. The study team observed larger decreases for the early-adopting cohort compared with the late-adopting cohort.

Conclusions and relevance: Through the application of rigorous methods (standard definitions and longitudinal time series analysis with adjustment for secular trends), this study provides a more thorough analysis of the association between the Partnership for Patients hospital engagement network model and reductions in hospital-acquired conditions. These findings strengthen previous claims of an association between this model and improvement. However, inconsistent observations across hospital-acquired conditions when adjusted for secular trends suggests that some caution regarding attributing all effects observed to this model is warranted.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Coffey reported grants from the US Centers for Medicare & Medicaid Services and fees from Children’s Hospitals Solutions for Patient Safety. Dr Purcell reported fees from Children’s Hospitals Solutions for Patient Safety and previously received salary support from Cincinnati Children’s Hospital during the conduct of the study. Dr Muething reported grants from Ohio Solutions for Patient Safety and from the US Center for Medicare & Medicaid Services during the conduct of the study. Dr Saysana reported fees from Solutions for Patient Safety during the conduct of the study and fees from Indianapolis Coalition for Patient Safety Indiana University Health Physicians outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Adverse Drug Event, Catheter-Associated Urinary Tract Infection (CAUTI), Central Catheter–Associated Bloodstream Infection (CCABSI), and Fall (Moderate or Greater Harm) Rates Before and After Implementation of Solutions for Patient Safety (SPS)
Dots indicate the hospital-level average in hospital-acquired condition rates over time. The orange slope lines were estimated using an interrupted time series model. The orange dashed lines represent 95% CIs of the slope lines. The vertical blue line indicates time of the SPS initiation.
Figure 2.
Figure 2.. Pressure Injury (PI), Surgical Site Infection (SSI), Ventilator-Associated Pneumonia (VAP), and Venous Thromboembolism (VTE) Event Rates Before and After Implementation of Solutions for Patient Safety (SPS)
Dots indicate the hospital-level average in hospital-acquired condition rates over time. The orange slope lines were estimated using an interrupted time series model. The orange dashed lines represent 95% CIs of the slope lines. The vertical blue line indicates time of the SPS initiation.
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References

    1. US Centers for Medicare & Medicaid Services . Partnership for Patients and the hospital improvement innovation networks: continuing forward momentum on reducing patient harm. Accessed June 16, 2022. https://www.cms.gov/newsroom/fact-sheets/partnership-patients-and-hospit...
    1. Perla RJ, Pham H, Gilfillan R, et al. . Government as innovation catalyst: lessons from the early center for Medicare and Medicaid innovation models. Health Aff (Millwood). 2018;37(2):213-221. doi:10.1377/hlthaff.2017.1109 - DOI - PubMed
    1. Conway P, Wagner D, McGann P, Joshi M. Did hospital engagement networks actually improve care? N Engl J Med. 2014;371(21):2040-2041. doi:10.1056/NEJMc1411298 - DOI - PubMed
    1. Pronovost P, Jha AK. Did hospital engagement networks actually improve care? N Engl J Med. 2014;371(8):691-693. doi:10.1056/NEJMp1405800 - DOI - PubMed
    1. Lyren A, Brilli RJ, Zieker K, Marino M, Muething S, Sharek PJ. Children’s hospitals’ solutions for patient safety collaborative impact on hospital-acquired harm. Pediatrics. 2017;140(3):e20163494. doi:10.1542/peds.2016-3494 - DOI - PubMed

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