Hospital performance—ideally a way to track patient safety and clinical outcomes—can largely be determined by how metrics are measured. A new review article specifically links changes in how catheter-associated urinary tract infections (CAUTIs) are defined with subsequent artificially improved hospital performance scores.
CAUTIs are preventable healthcare-associated infections that are tracked as part of the federal value-based incentive programs that give financial bonuses and penalties to hospitals based on hospital performance measures reported to the Centers for Disease Control (CDC) and Prevention’s National Healthcare Safety Network. Researchers from Boston University School of Medicine (BUSM) have found that although hospitals have federally reported significantly improved CAUTI rates since 2015, the root-cause of this trend is not easily identified.
Using CAUTI data reported by approximately 600 hospitals to the CDC’s National Healthcare Safety Network, the researchers found that CAUTI rates significantly decreased by 42 percent “immediately after” federal value-based incentive programs were implemented. “While this may seem like an effect of the programs, the large decline CAUTI rates was actually due to a concurrent change in which infections “count” as CAUTI,” explained corresponding author Heather Hsu, MD, assistant professor of pediatrics. Further review reveals the updated reportable definition of a CAUTI was implemented in 2015 and no longer included certain types of infections.
According to the researchers, these findings are important because change in the CAUTI definition likely led to artificial inflation of hospitals’ performance scores unrelated to changes in patient safety. “The case of CAUTI is an illustration of how measurement changes can not only impact evaluations of hospital performance but also potentially lead to inappropriate assessments of financial rewards or penalties that do not reflect meaningful differences in patient safety or hospital performance,” added Dr. Hsu.
In the era of continued quality improvement, rethinking and questioning the ways we measure hospital performance not only can lead to more appropriate understanding of where we are, but can also lead to long-term enhancement of patient care.
These findings appear online in in the journal Infection Control and Hospital Epidemiology.
Funding for this study was provided by the Agency for Healthcare Research and Quality (T32HS000063, K08HS025008 and 2R01HS018414-06).
Submitted by Tara Shrout, MD