Expanding CMS' definition of hospital-acquired conditions may better help hospitals improve patient safety, according to a study in the American Journal of Medical Quality.
Researchers developed an expanded set of HACs using the present-on-admission indicator and secondary diagnoses on 500,000 ICD-9-CM-coded discharge abstracts. They identified 138 secondary condition clusters as "potential inpatient complications," including 16 CMS-defined HACs.
Sixteen percent of the sample of 500,000 inpatients developed at least one PIC in the hospital, while less than 1 percent of inpatients developed a HAC as defined by CMS. Overall, the PICs were associated with 5 excess deaths per 1,000 discharges, 0.4 additional hospital days per discharge and an additional $950 in costs per discharge. Twenty-two PICs were associated with increased mortality, 79 were associated with increased length of stay and 88 were associated with increased costs. In contrast, 12 of the 16 PICs that were identical to CMS HACs had no statistically significant association with mortality, length of stay or costs.
While recognizing their method's limitations, including the fact that coded discharge abstracts may not be complete and that they did not differentiate potentially preventable conditions, the authors suggested PICs could be more useful to hospitals in improving patient safety. They outlined three main benefits of using ICD-9 codes and the present-on-admission designation to identify hospital-acquired conditions:
• It can broaden hospitals' ability to identify and address PICs.
• It can more effectively identify which hospitals perform better than others in certain areas.
• It can be more effective at screening for HACs than reviewing all patient records.
"The set of CMS HACs has provided a sound foundational set of potentially preventable HACs for the field. However, most CMS-defined HACs rarely occur. With such a narrow list, hospitals are missing opportunities to identify and improve care processes for other HACs whose elimination could substantially improve care by lowering mortality, reducing LOS, and decreasing costs," they wrote.
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