Abstract 1061: Variation in the Number of Hospital Acquired Conditions at Heart Hospitals Among Medicare Beneficiaries in Fiscal Year 2007
Objective: The Medicare program defines Hospital Acquired Conditions (HAC) as events that should never occur during a Medicare beneficiary (MB) hospitalization. The purpose of this study is to report the average number of HAC events among MB undergoing 3 procedures: isolated CABG surgery, any cardiac valve (VALVE) surgery, and any PCI.
Methods: This retrospective study examined Medicare Provider Analysis and Review (MedPar) Files for fiscal year 2007. The study population consists of 1,131 hospitals that performed all three procedures on at least one MB during the study period. ICD-9-CM codes were used to identify the following HAC events: foreign body, air embolism, blood incompatibility, pressure ulcers, fall/trauma, catheter associated UTI, vascular catheter infection, poor glycemic control, and mediastinitis post CABG surgery. Performance class was defined by assessing a point for each time a hospital ranked in the bottom 10% (defined by number of HACs) for each type of procedural admission.
Findings: The table⇓ reports for each of the three procedures, the average number of HAC events and the number of hospitals where no MB experienced an HAC by performance class. There were 740 hospitals that never ranked in the bottom 10% for any procedure type and averaged less than 2 HACs per year across the 3 procedures. In this top class between 257 and 575 hospitals had no MB experience an HAC for any given procedure type. However, the 133 hospitals in the bottom two classes averaged 12.8 HACs per year across the three heart procedures and at least 2 MB experienced an HAC in every hospital for each procedure in Class 3.
Conclusions: Our findings indicate that HAC events are relatively rare, overall. However, they are congregated in a small number (~10%) of hospitals providing cardiac surgery. There is opportunity to reduce these complications by focusing quality improvement in those hospitals.