Incidence of Hospital-Acquired Conditions in the Partnership for Patients: Estimates and Projected and Measured Impact
Exhibit A1 provides the 2013 data on HACs. The HACs that are the focus of the PfP initiative are shown, as well as the source of the data and the corresponding measures related to each HAC. The rate for 2013 is 121 HACs per 1,000 discharges, which is a 17 percent reduction from the 2010 baseline of 145 HACs per 1,000 discharges before the start of the PfP initiative.
Exhibit A1. 2013 AHRQ National Scorecard Data on HACs (Calculated August 18, 2015)
| PfP Hospital-Acquired Conditions | Final 2013 PfP HACs | |||
|---|---|---|---|---|
| Partnership for Patients Hospital-Acquired Condition | Source (& Data Year) | Measure | PfP HACsa | PfP Measured HACs per 1,000 Discharges |
| ADEs | MPSMS(2013) | ADE Associated With Digoxin | 8,800 | 0.27 |
| MPSMS (2013) | ADE Associated With Hypoglycemic Agents | 760,000 | 23.3 | |
| MPSMS (2013) | ADE Associated With IV Heparin | 170,000 | 5.1 | |
| MPSMS (2013) | ADE AssociatedWith Low Molecular Weight Heparin and Factor Xa Inhibitor | 240,000 | 7.3 | |
| MPSMS (2013) | ADE Associated With Warfarin | 140,000 | 4.3 | |
| MPSMS (2013) | Total ADE (rounded sum of above 5 >measures) | 1,3 20,000 | 40.3 | |
| CAUTis | MPSMS (2013) | Catheter-Associated Urinary Tract Infections | 290,000 | 8.8 |
| CLABSis | MPSMS (2013) | Blood Stream Infections Associated With Central Venous Catheters | 9,200 | 0.28 |
| Falls | MPSMS (2013) | In-Hospital Patient Falls | 240,000 | 7.2 |
| Obstetric Adverse Events | PSI (2013) | OB Trauma in Vaginal Delivery With (PSI18) and Without Instrument (PSI19) | 77,000 | 2.4 |
| Pressure Ulcers | MPSMS (2013) | Hospital-Acquired Pressure Ulcers | 1,060,000 | 32.5 |
| Surgical Site Infections | NHSN (2013) | SSis for 17 selected procedures | 79,000 | 2.4 |
| VAPs | MPSMS (2013) | Ventilator-Associated Pneumonia | 37,000 | 1.1 |
| VTEs | MPSMS (2013) | Postoperative Venous Thromboembolic Events | 23,000 | 0.71 |
| All Other Hospital-Acquired Conditions | MPSMS (2013) | Femoral Artery Puncture for Catheter Angiographic Procedures | 59,000 | 1.8 |
| MPSMS (2013) | Adverse Events Associated With Hip Joint Replacements | 21,000 | 0.63 | |
| MPSMS (2013) | Adverse Events Associated With Knee Joint Replacements | 14,000 | 0.42 | |
| MPSMS (2013) | Contrast Nephropathy Associated With Catheter Angiography | 250,000 | 7.6 | |
| MPSMS (2013) | Hospital-Acquired MRSA | 11,000 | 0.35 | |
| MPSMS (2013) | Hospital-Acquired VRE | 10,000 | 0.31 | |
| MPSMS (2013) | Hospital-Acquired Antibiotic-Associated C. difficile | 100,000 | 3.1 | |
| MPSMS (2013) | Mechanical Complications Associated With Central Venous Catheters | 110,000 | 3.3 | |
| MPSMS (2013) | Postoperative Cardiac Events for Cardiac and Non- cardiac Surgeries | 35,000 | 1.1 | |
| MPSMS (2013) | Postoperative Pneumonia | 65,000 | 2.0 | |
| PSI (2013) | Iatrogenic Pneumothorax (PSI 6) | 12,000 | 0.37 | |
| PSI (2013) | Post-Op Hemorrhage or Hematoma (PSI 9) | 20,000 | 0.61 | |
| PSI (2013) | Post-Op Respiratory Failure (PSI 11) | 52,000 | 1.6 | |
| PSI (2013) | Accidental Puncture or Laceration (PSI 15) | 63,000 | 1.9 | |
| MPSMS (2013) & PSI (2013) | Total All Other HAGs (sum of above 14 measures) | 822,000 | 25.1 | |
| Total 2013 PfP HACs and HACs per 1,000 discharges (rounded) | 3,957,200 | 121 | ||
a. Normalized to 32,750,000 Discharges-Based on 2010 Baseline.
Source: AHRQ National Scorecard Estimates from Medicare Patient Safety Monitoring System, National Healthcare Safety Network, and Healthcare Cost and Utilization Project.
Exhibit A2 shows the summary results for 2010 and 2013 after measurement of HACs was implemented and measured values replaced the baseline estimates shown in Exhibit A4 for 2010. Exhibit A3 shows just the percent change in HACs from the 2010 baseline to the 2013 rate. The cost savings and death reductions estimated for 2013 in Exhibit A2 are based on the measured 2010 and 2013 HACs and the estimated rates shown in Exhibit 1 and Exhibit A4 as to the additional cost per HAC and the additional inpatient mortality per HAC. As noted in the main body of this document, the overall measurement strategy for the PfP was published in the Journal of Patient Safety in September 2014 (http://journals.lww.com/journalpatientsafety/Abstract/2014/09000/An_Overview_of_Measurement_Activities_in_the.2.aspx), and specific details as to how the HAC data and rates shown were acquired and calculated was posted starting in May 2014 on the AHRQ Web site; methods and 2010-2012 data are available at http://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html#methods.
Exhibit A2. AHRQ National Scorecard HACs for 2013 vs. 2010, and Projected 2013 Cost Savings and Reductions in Deaths Associated With HACs
| PfP Hospital-Acquired Condition | 2010 Measured Baseline for HACsa | 2013 Measured HACsa | Measured Reduction in HACsb | Percent Reduction in Measured HACsc | Projected Cost Savings in 2013d | Projected Reductions in Deaths in 2013e |
|---|---|---|---|---|---|---|
| Adverse Drug Events | 1,621,000 | 1,320,000 | 301,000 | 19% | $1,505,000,000 | 6,020 |
| Catheter- Associated Urinary Tract Infections | 400,000 | 290,000 | 110,000 | 28% | $110,000,000 | 2,563 |
| Central Line-Associated Bloodstream Infections | 18,000 | 9,200 | 8,800 | 49% | $149,600,000 | 1,628 |
| Falls | 260,000 | 240,000 | 20,000 | 8% | $144,680,000 | 1' 100 |
| Obstetric Adverse Events | 82,000 | 77,000 | 5,000 | 6% | $15,000,000 | 7 |
| Pressure Ulcers | 1,320,000 | 1,060,000 | 260,000 | 20% | $4,420,000,000 | 18,824 |
| Surgical Site Infections | 96,000 | 79,000 | 17,000 | 18% | $357,000,000 | 479 |
| Ventilator-Associated Pneumonias | 38,000 | 37,000 | 1,000 | 3% | $21,000,000 | 144 |
| (Post-op) Venous Thromboembolisms | 28,000 | 23,000 | 5,000 | 18% | $40,000,000 | 520 |
| All Other HACs | 894,000 | 822,000 | 72,000 | 8% | $1,224,000,000 | 3,262 |
| Totals | 4,757,000 | 3,957,200 | 799,800 | 17% | $7,986,280,000 | 34,547 |
a. Rounded.
b. 2010 vs. 2013.
c.From 2010 to 2013.
d.Based on Measured Reductions of HACs in 2013 vs. 2010, and Baseline Projections Made in 2011 on the Additional Cost per HAC.
e.Based on Measured Reductions of HACs in 2013 vs. 2010, and Baseline Projections Made in 2011 on the Additional Inpatient Mortality per HAC.
Exhibit A3. Percent Reduction in AHRQ National Scorecard HACs from 2010 to 2013
Exhibit A4 contains projections of the estimated impact of the initiative that would be launched in April 2011 as the "Partnership for Patients." Several projections were needed for each of the types of hospital-acquired conditions (HACs) that were selected for special focus. For each HAC, the incidence, preventability, cost, and additional mortality were assessed; and a goal was set as to the percentage of preventable HACs to be prevented.17 These assessments and the associated projections are provided below in Exhibit A4.
The basis of the derivation of the overall 44 percent preventability estimate (which corresponds to the previously referenced 2010 OIG estimate) is shown in the table, as is the basis for the PfP goal of a 40 percent reduction in preventable HACs. Also shown is the estimate that, if 44 percent were considered preventable, the overall PfP goal to prevent 40 percent of preventable HACs would result in reducing the overall rate of HACs by approximately 17 percent.
The sources of the estimates in Exhibit A4 were identified based primarily on peer-reviewed articles published through early 2011. Other sources included reports and other information from HHS and other federally sponsored programs, and expert opinions.
Complete references to the documents accessed to make these assessments and projections, organized by HAC type, are provided at the end of this document. In general, all references listed were available in early 2011, except for several documents that were available only in a draft form prior to the launch of the PfP in April 2011; in these cases the final document is listed.
Exhibit A4. Estimates, Goals, and Projections for HACs at the Launch of PfP Initiative in 2011
| PfP Hospital-Acquired Condition | Estimated U.S. National Incidence of HACs (2010) | Estimated HAC Preventability as of 2010/2011 | PfPGoal at Launch of Programa | Combined Goal for HAC Reductionb | PfP HAC Reduction Goalc | Estimated PfP Additional Cost* per HAC |
|---|---|---|---|---|---|---|
| Adverse Drug Events | 1,900,000 | 50% | 50% | 25% | 475,000 | $5,000 |
| Catheter-Associated Urinary Tract Infections | 530,000 | 40% | 50% | 20% | 106,000 | $1,000 |
| Central Line-Associated Bloodstream Infections | 40,000 | 50% | 50% | 25% | 10,000 | $17,000 |
| Falls | 200,000 | 25% | 50% | 12.5% | 25,000 | $7,234 |
| Obstetric Adverse Events | 380,000 | 30% | 50% | 15% | 57,000 | $3,000 |
| Pressure Ulcers | 250,000 | 50% | 50% | 25% | 62,500 | $17,000 |
| Surgical Site Infections | 110,000 | 35% | 20% | 7% | 7,700 | $21,000 |
| Ventilator-Associated Pneumonias | 40,000 | 50% | 50% | 25% | 10,000 | $21,000 |
| (Post-op) Venous Thrombo-Embolisms | 100,000 | 40% | 50% | 20% | 20,000 | $8,000 |
| All Other HACs | 2,430,000 | 44% | 25% | 11% | 267,300 | $17,000 |
| Totals | 5,980,000 | 44.1% | 39.3% | 17.4% | 1,040,500 | NA |
a. Percentage of Preventable HACs.
b. Preventability x Goal.
c. Fewer HACs in 2014* vs. 2010 Baseline.
*Additional costs per HAC for Falls and Pressure Ulcers were modified in 2012 from earlier higher projections. The earlier estimates had been wrongly based on the full cost of a hospital stay that included a fall or a hospital-acquired pressure ulcer, rather than on the incremental cost due to the HAC.
Exhibit A4. Estimates, Goals, and Projections for HACs at the Launch of PfP Initiative in 2011 (continued)
| PfP Hospital-Acquired Condition | Estimated PfP Additional Inpatient Mortality per HAC | Projected PfP Cost Savings in 2014 if 2014 Goal Met | Projected Reductions in Deaths Associated With HACs in 2014 if 2014 Goal Met |
|---|---|---|---|
| Adverse Drug Events | .020 | $2,375,000,000 | 9,500 |
| Catheter-Associated Urinary Tract Infections | .023 | $106,000,000 | 2,470 |
| Central Line-Associated Bloodstream Infections | .185 | $170,000,000 | 1,850 |
| Falls | .055 | $180,850,000 | 1,375 |
| Obstetric Adverse Events | .0015 | $171,000,000 | 84 |
| Pressure Ulcers | .072 | $1,062,500,000 | 4,525 |
| Surgical Site Infections | .028 | $161,700,000 | 217 |
| Ventilator-Associated Pneumonias | .144 | $210,000,000 | 1,438 |
| (Post-op) Venous Thrombo-Embolisms | .104 | $160,000,000 | 2,080 |
| All Other HACs | .045 | $4,544,100,000 | 12,109 |
| Totals | NA | $9,141,150,000 | 35,647 |
- In 2011, this work was completed using the best available information to generate 2010 incidences and other information regarding the HACs. After these estimates were made, processes were established to measure and estimate national HACs starting with a 2010 measured baseline (4,757,000 HACs). In order to produce consistent estimates of cost savings and deaths averted for 2010 to 2013, the per-HAC estimates established for the costs and deaths associated with HACs in 2011 have not been modified.
