Full title
Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions

1. Agency for Healthcare Research and Quality. Working for Quality: National Quality Strategy (NQS) Reports and Annual Updates. 2011-2016. Available at:

2. Agency for Healthcare Research and Quality. Working for Quality: About the National Quality Strategy (NQS). Available at:

3. Office of Disease Prevention and Health Promotion. National Action Plan to prevent health care-associated infections: Road map to elimination. Available at:

4. Office of Disease Prevention and Health Promotion. National Action Plan for ADE prevention. Available at

5. Centers for Medicare & Medicaid Services. Partnership for Patients. Available at:

6. Agency for Healthcare Research and Quality. Comprehensive Unit-based Safety Program (CUSP) Toolkit. Available at

7. Agency for Healthcare Research and Quality. AHRQ National Scorecard on Rates of Hospital-Acquired Conditions, 2010 to 2015. Available at

8. Agency for Healthcare Research and Quality. AHRQ Quality and Safety Review System. Available at

9. Centers for Medicare & Medicaid Services (CMS). Hospital-Acquired Condition Reduction Program. Available from:

10. Centers for Medicare & Medicaid Services. Partnership for Patients: About the Partnership. Available at

11. McGlynn EA, McDonald KM, Cassel CK. Measurement is essential for improving diagnosis and reducing diagnostic error: a report from the Institute of Medicine. JAMA. 2015 Dec;314(23):2501-02.

12. Institute of Medicine (1999). To err is human: building a safer health system. Available at :

13. Institute of Medicine (2001). Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academies Press. Available at:

14. Centers for Medicare & Medicaid Services. About the Partnership: Community Based Care Transitions Program. Available at:

15. Centers for Medicare & Medicaid Services. Partnership for Patients Initiative. Available at:

16. Agency for Healthcare Research and Quality. 2013 annual hospital-acquired condition rate and estimates of cost savings and deaths averted from 2010 to 2013. Available at:

17. Centers for Medicare & Medicaid Services. Hospital-acquired conditions (present on admission indicator). Available at:

18. Centers for Medicare & Medicaid Services. Fiscal Year (FY) 2016 results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program. 2015. Available at:

19. Classen DC, Munier W, Verzier N, et al. Measuring patient safety: The Medicare Patient Safety Monitoring System (past, present, and future). J Patient Safety. 2016; preview online. Available at:

20. Agency for Healthcare Research and Quality. Saving lives and saving money: hospital-acquired conditions update interim data from national efforts to make care safer, 2010-2014. Available at:

21. Brady, J. New system aims to improve patient safety monitoring. Agency for Healthcare Research and Quality, Oct 2016. Available at:

22. Agency for Healthcare Research and Quality. AHRQ Quality and Safety Review System (QSRS). Available at:

23. Winters BD, Bharmal A, Wilson RF, et al. Validity of the Agency for Health Care Research and Quality Patient Safety Indicators and the Centers for Medicare and Medicaid Hospital-Acquired Conditions: A systematic review and meta-analysis. Med Care. 2016 Dec;54(12):1105-11.

24. Makary MA, Daniel M. Medical error—the third leading cause of death in the US. BMJ. 2016 May;353:i2139. DOI:10.1136/bmj.i2139

25. Jha A, Pronovost P. Toward a safer health care system: the critical need to improve measurement. JAMA. 2016 May;315(17):1831-2. DOI:10.1001/jama.2016.3448

26. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 July;6(7): e1000097. DOI:10.1371/journal.pmed.1000097

27. Bureau of Labor Statistics. Producer Price-Index. Industry Data, General medical and surgical hospitals (series PCU622110). Available at:

28. Berger S. Fundamentals of healthcare financial issues and activities. San Francisco, CA: John Wiley and Sons: 2008.

29. Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions. Cochrane DCollaboration, 2011. Available at:

30. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005 Apr;5:13.

31. Kontopantelis E, Reeves D. metaan: Random-effects meta-analysis. Stata J. 2010;10(3):395-407.

32. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clin Trials. 1986 Sept;7(3):177-88.

33. DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015 Nov;45(Pt A):139-45.

34. Hoekstra JW, Pollack CV, Roe MT, et al. Improving the care of patients with non-ST-elevation acute coronary syndromes in the emergency department: the CRUSADE initiative. Acad Emerg Med. 2002 Nov;9(11):1146-55.

35. Classen DC, Jaser L, Budnitz DS. Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance. Jt Comm J Qual Patient Saf. 2010 Jan;36(1):12–21.

36. Alexander KP. Excess dosing of antiplatelet and antithrombin agents in the treatment of non–ST-segment elevation acute coronary syndromes. JAMA. 2005 Dec;294(24):1-9.

37. LaPointe NMA, Chen AY, Alexander KP, et al. Enoxaparin dosing and associated risk of in-hospital bleeding and death in patients with non ST-segment elevation acute coronary syndromes. Arch Intern Med. 2007 Jul;167(14):1539-44.

38. Seigerman M, Cavallaro P, Itagaki S, et al. Incidence and outcomes of heparin-induced thrombocytopenia in patients undergoing cardiac surgery in North America: an analysis of the nationwide inpatient sample. J Cardiothorac Vasc Anesth. 2014 Feb;28(1):98-102.

39. Goudie A, Dynan L, Brady PW, et al. Costs of venous thromboembolism, catheter-associated urinary tract infection, and pressure ulcer. Pediatrics. 2015 Sep;136(3):432-9.

40. Byrn JC, Brooks MK, Belding-Schmitt M, et al. Impact of urinary tract infection definitions on colorectal outcomes. J Surg Res. 2015 Dec;199(2):331-7.

41. Sammon J, Trinh VQ, Ravi P, et al. Health care-associated infections after major cancer surgery. Cancer. 2013 Jun;119(12):2317-24.

42. Glied S, Cohen B, Liu J, et al. Trends in mortality, length of stay, and hospital charges associated with health care-associated infections, 2006-2012. Am J Infect Control. 2016 Sep;44(9):983-9.

43. Dasenbrock HH, Rudy RF, Smith TR, et al. Hospital-acquired infections after aneurysmal subarachnoid hemorrhage: a nationwide analysis. World Neurosurg. 2016 Apr;88:459-74.

44. Murthy SB, Moradiya Y, Shah J, et al. Nosocomial infections and outcomes after intracerebral hemorrhage: a population-based study. Neurocrit Care. 2016 Oct;25(2):178-84.

45. Yi SH, Baggs J, Gould CV, et al. Medicare reimbursement attributable to catheter-associated urinary tract infection in the inpatient setting: a retrospective cohort analysis. Med Care. 2014 Jun;52(6):469-78.

46. Kilgore ML, Ghosh K, Beavers CM, et al. The costs of nosocomial infections. Med Care. 2008 Jan 1;46(1):101-4.

47. Dimick JB, Pelz RK, Consunji R, et al. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg. 2001 Feb;136(2):229–34.

48. Warren DK, Quadir WW, Hollenbeak CS, et al. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006 Aug;34(8):2084-9.

49. Bates DW, Pruess K, Souney P, et al. Serious falls in hospitalized patients: correlates and resource utilization. Am J of Med. 1995 Aug;99(2):137-43.

50. Spetz J, Brown DS, Aydin C. The economics of preventing hospital falls: demonstrating ROI through a simple model. Journal of Nursing Administration. 2015 Jan 1;45(1):50-7.

51. Bohl AA, Phelan EA, Fishman PA, et al. How are the costs of care for medical falls distributed? The costs of medical falls by component of cost, timing, and injury severity. The Gerontologist. 2012 Oct 1;52(5):664-75.

52. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults—United States. Journal of safety research. 2016 Sep 30;58:99-103.

53. Memtsoudis SG, Dy CJ, Ma Y, et al. In-hospital patient falls after total joint arthroplasty: incidence, demographics, and risk factors in the United States. Journ of Arthroplasty. 2012 Jun 30;27(6):823-8.

54. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003 Oct;290(14):1868-74.

55. Hunt TD, Guglielminotti J, Li G. Costs associated with anesthesia-related adverse events during labor and delivery in New York state, 2010. Anesth Analg. 2016 Jun;122(6):2007-16.

56. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2015. National vital statistics report; vol 66, no 1. Hyattsville, MD: National Center for Health Statistics: 2017.

57. MacDorman MF, Declercq E, Cabral H, et al. Recent increases in the U.S. maternal mortality rate: disentangling trends from measurement issues. Obstet Gynecol. 2016;128(3):447-56.

58. Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Available at:

59. Grobman MA, Bailit JL, Rice MM, et al. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol. 2014 Apr;123(4):804-10.

60. Callaghan WM, Mackay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003. Am J Obstet Gynecol. 2008 Aug;199(2):133.e1-8.

61. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012 Nov;120(5):1029-36.

62. Creanga AA, Bateman BT, Kuklina EV, et al. Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010. Am J Obstet Gynecol. 2014 May;210(5):435.e1-8.

63. Joseph KS, Lisonkova S, Muraca GM, et al. Factors underlying the temporal increase in maternal mortality in the United States. Obstet Gynecol. 2017 Jan;129(1):91-100.

64. Bauer K, Rock K, Nazzal M, et al. Pressure ulcers in the United States' inpatient population from 2008 to 2012: results of a retrospective nationwide study. Ostomy Wound Manage. 2016 Nov;62(11):30-8.

65. Mendizabal A, Thibault DP, Willis AW. Patient safety events in hospital care of individuals with epilepsy. Epilepsia. 2016 Aug;57(8):1301-9.

66. Spector WD, Limcangco R, Owens PL, et al. Marginal hospital cost of surgery-related hospital-acquired pressure ulcers. Medical care. 2016 Sep 1;54(9):845-51.

67. Boltz MM, Hollenbeak CS, Julian KG, et al. Hospital costs associated with surgical site infections in general and vascular surgery patients. Surgery. 2011 Nov;150(5):934-42.

68. Eagye KJ, Nicolau DP, Kuti JL. Impact of superinfection on hospital length of stay and costs in patients with ventilator-associated pneumonia. Semin Respir Crit Care Med. 2009 Feb;30(1):116–23.

69. Kim SP, Shah ND, Karnes RJ, et al. The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer. J Urol. 2012 Jun;187(6):2011-7.

70. de Lissovoy G, Fraeman K, Hutchins V, et al. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009 Jun;37(5):387-97.

71. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012 Mar;33(3):250-6.

72. Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large U.S. database. Chest. 2002 Dec;122(6):2115-21.

73. Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med. 2003 May;31(5):1312-7.

74. Restrepo MI, Anzueto A, Arroliga AC, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization. Infect Control Hosp Epidemiol. 2010 May;31(5):509-15.

75. Klompas M, Khan Y, Kleinman K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS One. 2011 Mar;6(3):e18062.

76. Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, et al. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics. 2003 Dec;112(6 Pt 1):1283-9.

77. Gupta S, Boville BM, Blanton R, et al. A multicentered prospective analysis of diagnosis, risk factors, and outcomes associated with pediatric ventilator-associated pneumonia. Pediatr Crit Care Med. 2015 Mar;16(3):e65-73.

78. Magill SS, Klompas M, Balk R, et al. Developing a new, national approach to surveillance for ventilator-associated events. Am J Crit Care 2013 Nov;22(6):469-473.

79. Jacob JT, Murphy DJ. Defining the current landscape of ventilator-associated events: significant burden and potential to improve. Crit Care Med. 2016 Dec;44(12);2280-1.

80. Hayashi Y, Morisawa K, Klompas M, et al. Toward improved surveillance: The impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units. Clin Infect Dis 2013 Feb;56(4):471-7.

81. Gephart MGH, Zygourakis CC, Arrigo RT, et al. Venous thromboembolism after thoracic/thoracolumbar spinal fusion. World Neurosurg. 2012 Nov;78(5):545-52.

82. Hennessey P, Semenov YR, Gourin CG. The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery. Laryngoscope. 2012 Oct;122(10):2199-204.

83. Ali M, Ananthakrishnan AN, McGinley EL, et al. Deep vein thrombosis and pulmonary embolism in hospitalized patients with cirrhosis: a nationwide analysis. Dig Dis Sci. 2011 Jul;56(7):2152-9.

84. Satahoo SS, Parikh PP, Naranjo D, et al. Are burn patients really at risk for thrombotic events? J Burn Care Res. 2015;36(1):100-4.

85. Trinh VQ, Karakiewicz PI, Sammon J, et al. Venous thromboembolism after major cancer surgery: temporal trends and patterns of care. JAMA Surg. 2014 Jan;149(1):43-9.

86. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008 Sep;103(9):2272-80.

87. Wu H, Nguyen GC. Liver cirrhosis is associated with venous thromboembolism among hospitalized patients in a nationwide U.S. study. Clin Gastroenterol Hepatol. 2010 Sep;8(9):800-5.

88. Agency for Healthcare Research and Quality. AHRQ National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015. Available at:

89. Scott RD. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Division of Healthcare Quality Promotion National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention; 2009.

90. Agency for Healthcare Research and Quality. Toolkit for reducing CAUTI in hospitals. Available at

91. Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology. 2010 Apr 1;31(04):319-26.

92. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Eng J Med. 2006 Dec;355:2725-32.

93. Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Eng J Med. 2016 Jun;374(22):2111-9.

94. Berenholtz SM, Pharm JC, Thompason DA, et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol. 2011 Apr;32(4):305-14.

Page last reviewed November 2017
Page originally created November 2017
Internet Citation: Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. Content last reviewed November 2017. Agency for Healthcare Research and Quality, Rockville, MD.