Impact of Quality Improvement Support on Hospital Readmissions and Patient Safety Outcomes: A Quasi-Experimental Study of a National Quality Improvement Initiative
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
The Centers for Medicare & Medicaid Services (CMS) administers the Hospital Quality Improvement Contractor (HQIC) program to improve healthcare quality and safety in hospitals serving Medicare beneficiaries. These contractors provided technical assistance to small, rural hospitals, and/or to hospitals with lower quality ratings. This study aimed to evaluate the program’s effectiveness in addressing two priority areas: reducing hospital readmissions and increasing patient safety.
Methods
A quasi-experimental design was used to assess the impact of HQIC support on 30-day all-cause readmissions and eight patient safety outcomes in hospitals that received support between October 1, 2020, and December 31, 2023 (N = 1,929). Patient safety outcomes included adverse drug events (ADEs) and healthcare-associated infections (HAI). A difference-in-difference model specification with a Poisson generalized estimating equation was used to compare hospitals receiving support for each outcome to matched hospitals that did not receive HQIC support.
Results
Receiving HQIC support was associated with a 1.4% reduction in the number of 30-day all-cause readmissions compared to hospitals with similar characteristics that did not receive HQIC support for readmissions. Hospitals receiving HQIC support for reducing catheter-associated urinary tract infections (CAUTI) showed a 17.4% reduction in the number of CAUTI events relative to hospitals that did not receive support. There was no statistically significant effect on the other outcomes.
Conclusions
The HQIC program support had an impact on reductions in hospital readmissions and reductions for one of the HAIs but not on other patient safety outcomes. These findings suggest a targeted approach in resource allocation may improve readmissions and CAUTI rates for small and rural hospitals.
Key Messages
What is already known on this topic
-
Hospital readmissions, adverse drug events in inpatient care, and healthcare-associated infections increase morbidity and mortality and are costly to the healthcare system, and evidence-based strategies exist to help reduce these events.
-
The Centers for Medicare & Medicaid Services implemented a national quality improvement initiative that provides training and technical assistance to hospitals, particularly to small and rural hospitals, to reduce readmissions and improve patient safety outcomes.
What this study adds
-
This study provides the opportunity to examine the impact of a national quality improvement effort on hospital readmissions and patient safety outcomes. Quality improvement support was associated with significant reductions in hospitals’ 30-day all-cause readmissions and catheter-associated urinary tract infections, but not with other patient safety indicators assessed.
How this study might affect research, practice or policy
-
The finding that quality improvement support to hospitals resulted in improved outcomes suggests the need for prioritization and investment in this approach.
-
The limited program impact on improving rare outcomes highlights the importance of aligning goals with the unique needs of smaller, rural hospitals in the design of future quality improvement programs.
