Exhibit A4 contains projections of the estimated impact of the initiative that would be launched in April 2011 as the "Partnership for Patients." Several projections were needed for each of the types of hospital-acquired conditions (HACs) that were selected for special focus. For each HAC, the incidence, preventability, cost, and additional mortality were assessed; and a goal was set as to the percentage of preventable HACs to be prevented.18 These assessments and the associated projections are provided below in Exhibit A4.
The basis of the derivation of the overall 44 percent preventability estimate (which corresponds to the previously referenced 2010 OIG estimate) is shown in the table, as is the basis for the PfP goal of a 40 percent reduction in preventable HACs. Also shown is the estimate that, if 44 percent were considered preventable, the overall PfP goal to prevent 40 percent of preventable HACs would result in reducing the overall rate of HACs by approximately 17 percent.
The sources of the estimates in Exhibit A4 were identified based primarily on peer-reviewed articles published through early 2011. Other sources included reports and other information from HHS and other federally sponsored programs, and expert opinions.
Complete references to the documents accessed to make these assessments and projections, organized by HAC type, are provided at the end of this document. In general, all references listed were available in early 2011, except for several documents that were available only in a draft form prior to the launch of the PfP in April 2011; in these cases the final document is listed.
Exhibit A4. Estimates, Goals, and Projections for HACs at the Launch of PfP initiative in 2011
|PfP Hospital-Acquired Condition||Estimated U.S. National Incidence of HACs (2010)||Estimated HAC Preventability as of 2010/2011||PfP Goal at Launch of Program (Percentage of Preventable HACs)||Combined Goal for HAC Reduction (Preventability x Goal)||PfP HAC Reduction Goal (Fewer HACs in 2014* vs. 2010 Baseline)||Estimated PfP Additional Cost* per HAC||Estimated PfP Additional Inpatient Mortality per HAC||Projected PfP Cost Savings in 2014 if 2014 Goal Met||Projected Reductions in Deaths Associated With HACs in 2014 if 2014 Goal Met|
|Adverse Drug Events||1,900,000||50%||50%||25%||475,000||$5,000||.020||$2,375,000,000||9,500|
|Catheter-Associated Urinary Tract Infections||530,000||40%||50%||20%||106,000||$1,000||.023||$106,000,000||2,470|
|Central Line-Associated Bloodstream Infections||40,000||50%||50%||25%||10,000||$17,000||.185||$170,000,000||1,850|
|Obstetric Adverse Events||380,000||30%||50%||15%||57,000||$3,000||.0015||$171,000,000||84|
|Surgical Site Infections||110,000||35%||20%||7%||7,700||$21,000||.028||$161,700,000||217|
|(Post-op) Venous Thrombo-embolisms||100,000||40%||50%||20%||20,000||$8,000||.104||$160,000,000||2,080|
|All Other HACs||2,430,000||44%||25%||11%||267,300||$17,000||.045||$4,544,100,000||12,109|
* Additional costs per HAC for Falls and Pressure Ulcers were modified in 2012 from earlier higher projections. The earlier estimates had been wrongly based on the full cost of a hospital stay that included a fall or a hospital-acquired pressure ulcer, rather than on the incremental cost due to the HAC.
18. In 2011, this work was completed using the best available information to generate 2010 incidences and other information regarding the HACs. After these estimates were made, processes were established to measure and estimate national HACs starting with a 2010 measured baseline (4,757,000 HACs). In order to produce consistent estimates of cost savings and deaths averted for 2010 to 2013, the per-HAC estimates established for the costs and deaths associated with HACs in 2011 have not been modified.