Declines in CDI rates linked to value-based incentive programs

Nov. 2, 2021

A study of more than 24 million admissions at 265 hospitals found an association between the federal government’s value-based incentive programs and a decline in the rates of healthcare facility–onset Clostridioides difficile (HO-CDI). The authors say the rate decline may reflect improvements in infection control and antibiotic stewardship.

Led by Mohammad Alrawashdeh, PhD, MSN, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, the study was published in JAMA Network Open.

Researchers analyzed data on HO-CDI rates in hospitalized adults from January 2013 and March 2019 at hospitals across 47 states and Washington, DC, finding that the incorporation of HO-CDI into value-based incentive programs was associated with a 6% decline in HO-CDI rates in the immediate post-policy quarter and a sustained 4% decline per quarter. The results were consistent, regardless of the testing method used at the hospital, the authors reported.

HO-CDI rates were targeted in two value-based incentive programs developed by the Centers for Medicare & Medicaid Services: Hospital Value-Based Purchasing (HVBP) and the Hospital-Acquired Conditions Reduction Program (HACRP). Both programs link financial incentives or penalties to performance on quality metrics. The programs were launched in October 2016.

A total of 24,332, 938 admissions, 109, 371, 136 patient-days, and 74 681 HO-CDI events were included in the study. Most hospitals were medium-sized (55%) not-for-profit (77%), teaching hospitals (70%), and located in metropolitan areas (86%).

“To our knowledge, this is the first HAI for which a CMS policy has been associated with improvement. Previously implemented CMS policies and the current VBIPs (value-based incentive programs) showed no evidence in reducing the rates of central catheter–associated bloodstream infections, surgical site infections after colon surgical procedures and abdominal hysterectomy procedures, catheter-associated urinary tract infections, and mediastinitis following coronary artery bypass graft surgery,” the authors wrote.

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