Saving Lives and Saving Money: Hospital-Acquired Conditions Update

Appendix

Full title
Appendix: Incidence of Hospital-Acquired Conditions in the Partnership for Patients: Estimates and Projected and Measured Impact

Exhibit A1 provides the 2014 data on HACs. The HACs that are the focus of the PfP initiative are shown, as well as the source of the data and the corresponding measures related to each HAC. The rate for 2014 is 121 HACs per 1,000 discharges, which is a 17 percent reduction from the 2010 baseline of 145 HACs per 1,000 discharges before the start of the PfP initiative.7

Exhibit A1. Interim 2014 AHRQ National Scorecard Data on HACs (Calculated November 19, 2015)

PfP Hospital-Acquired Conditions Interim 2014 PFP HACsa
Hospital-Acquired Condition Source (& Data Year) Measure PfP HACsb PfP Measured HACs per 1,000 Discharges
ADEs MPSMS (2013) ADE Associated With Digoxin 10,000 0.32
MPSMS (2014) ADE Associated With Hypoglycemic Agents 780,000 23.8
MPSMS (2014) ADE Associated With IV Heparin 200,000 6.0
MPSMS (2014) ADE Associated With Low Molecular Weight Heparin and Factor Xa Inhibitor 250,000 7.6
MPSMS (2014) ADE Associated With Warfarin 120,000 3.7
MPSMS (2014) Total ADE (rounded sum of above 5 measures) 1,360,000 41.4
CAUTIs MPSMS (2014) Catheter-Associated Urinary Tract Infections 250,000 7.6
CLABSIs MPSMS (2014) Blood Stream Infections Associated With Central Venous Catheters 5,000 0.2
Falls MPSMS (2014) In-Hospital Patient Falls 260,000 7.9
Obstetric Adverse Events PSI (2013) OB Trauma in Vaginal Delivery With (PSI 18) and Without Instrument (PSI 19) 77,000 2.4
Pressure Ulcers MPSMS (2014) Hospital-Acquired Pressure Ulcers 1,010,000 30.9
Surgical Site Infections NHSN (2013) SSIs for 17 selected procedures 79,000 2.4
VAPs MPSMS (2014) Ventilator-Associated Pneumonia 38,000 1.2
VTEs MPSMS (2014) Postoperative Venous Thromboembolic Events 16,000 0.49
All Other Hospital- Acquired Conditions MPSMS (2014) Femoral Artery Puncture for Catheter Angiographic Procedures 74,000 2.3
MPSMS (2014) Adverse Events Associated With Hip Joint Replacements 19,000 0.59
MPSMS (2014) Adverse Events Associated With Knee Joint Replacements 16,000 0.50
MPSMS (2014) Contrast Nephropathy Associated With Catheter Angiography 270,000 8.3
MPSMS (2014) Hospital-Acquired MRSA 17,000 0.52
MPSMS (2014) Hospital-Acquired VRE 11,000 0.34
MPSMS (2014) Hospital-Acquired Antibiotic-Associated C. difficile 93,000 2.8
MPSMS (2014) Mechanical Complications Associated With Central Venous Catheters 120,000 3.6
MPSMS (2014) Postoperative Cardiac Events for Cardiac and Non- cardiac Surgeries 34,000 1.0
MPSMS (2014) Postoperative Pneumonia 71,000 2.2
PSI (2013) Iatrogenic Pneumothorax (PSI 6) 12,000 0.37
PSI (2013) Post-Op Hemorrhage or Hematoma (PSI 9) 20,000 0.61
PSI (2013) Post-Op Respiratory Failure (PSI 11) 52,000 1.6
PSI (2013) Accidental Puncture or Laceration (PSI 15) 63,000 1.9
MPSMS (2014) and PSI (2013) Total All Other HACs (sum of above 14 measures) 872,000 26.6
Interim Total 2014 PfP HACs and HACs per 1,000 discharges (rounded) 3,967,000 121

a. 2014 Data for MPSMS-Based PFP HACs, and 2013 Data for PSI- and NHSN-Based PFP HACs.
b. Normalized to 32,750,000 Discharges—Based on 2010 Baseline.

Source: AHRQ National Scorecard Estimates from Medicare Patient Safety Monitoring System, National Healthcare Safety Network, and Healthcare Cost and Utilization Project.

Exhibit A2 shows the summary results for 2010 and interim 2014 after measurement of HACs was implemented and measured values replaced the baseline estimates shown in Exhibit A1 for 2010.

The interim cost savings and death reductions estimated for 2014 in Exhibit A2 are based on the measured 2010 and 2014 HACs and the estimated rates shown in Exhibit A3 as to the additional cost per HAC and the additional inpatient mortality per HAC.

As noted in the 2013 final report,7 the overall measurement strategy for the PfP was published in the Journal of Patient Safety in September 2014,8 and specific details as to how the HAC data and rates shown were acquired and calculated was posted starting in May 2014 on the AHRQ Web site; methods and data are online.7

Exhibit A3 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.9

The basis of the derivation of the overall 44 percent preventability estimate (which corresponds to the previously referenced 2010 Office of Inspector General estimate) is shown in Exhibit A3, 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 17.6 percent.

Complete references to the documents accessed to make these assessments and projections, organized by HAC type, are provided at the end of the 2013 final report.7

Exhibit A2. AHRQ National Scorecard HACs for Interim 2014 vs. 2010, and Projected 2014 Cost Savings and Reductions in Deaths Associated With HACs

PfP Hospital-Acquired Condition 2010 Measured Baseline for HACs (Rounded) Interim 2014 Measured HACs (Rounded) Measured Reduction in HACs (2010 vs. Interim 2014) Percent Reduction in Measured HACs (From 2010 to Interim 2014) Projected Cost Savings in 2014c Projected Reductions in Deaths in 2014d
Adverse Drug Events 1,621,000 1,360,000 261,000 16% $1,305,000,000 5,220
Catheter-Associated Urinary Tract Infections 400,000 250,000 150,000 38% $150,000,000 3,495
Central Line-Associated Bloodstream Infections 18,000 5,000 13,000 72% $221,000,000 2,405
Falls 260,000 260,000 0 0% $0 0
Obstetric Adverse Events 82,000 77,000 5,000 6% $15,000,000 7
Pressure Ulcers 1,320,000 1,010,000 310,000 23% $5,270,000,000 22,444
Surgical Site Infections 96,000 79,000 17,000 18% $357,000,000 479
Ventilator- Associated Pneumonias 38,000 38,000 0 0% $0 0
(Post-op) Venous Thromboembolisms 28,000 16,000 12,000 43% $96,000,000 1,248
All Other HACs 894,000 872,000 22,000 2% $374,000,000 997
Totals 4,757,000 3,967,000 790,000 17% $7,788,000,000 36,295

c. Based on Measured Reductions of HACs in 2014 vs. 2010, and Baseline Projections Made in 2011 on the Additional Cost per HAC.
d. Based on Measured Reductions of HACs in 2013 vs. 2010, and Baseline Projections Made in 2011 on the Additional Inpatient Mortality per HAC.

Exhibit A3. 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 Programe Combined Goal for HAC Reductionf PfP HAC Reduction Goalg Estimated PfP Additional Cost* per HAC
Adverse Drug Events 1,900,000 50% 50% 25% 475,000 $5,000
Catheter-Associated Urinary Tract Infections 530,000 40% 50% 20% 106,000 $1,000
Central Line-Associated Bloodstream Infections 40,000 50% 50% 25% 10,000 $17,000
Falls 200,000 25% 50% 12.5% 25,000 $7,234
Obstetric Adverse Events 380,000 30% 50% 15% 57,000 $3,000
Pressure Ulcers 250,000 50% 50% 25% 62,500 $17,000
Surgical Site Infections 110,000 35% 20% 7% 7,700 $21,000
Ventilator- Associated Pneumonias 40,000 50% 50% 25% 10,000 $21,000
(Post-op) Venous Thrombo- embolisms 100,000 40% 50% 20% 20,000 $8,000
All Other HACs 2,430,000 44% 25% 11% 267,300 $17,000
Totals 5,980,000 44.1% 39.3% 17.4% 1,040,500 NA

e. Percentage of Preventable HACs.
f. Preventability x Goal.
g. Fewer HACs in 2014* vs. 2010 Baseline.

* 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.

Exhibit A3. Estimates, Goals, and Projections for HACs at the Launch of PfP initiative in 2011 (continued)

PfP Hospital-Acquired Condition 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 .020 $2,375,000,000 9,500
Catheter-Associated Urinary Tract Infections .023 $106,000,000 2,470
Central Line-Associated Bloodstream Infections .185 $170,000,000 1,850
Falls .055 $180,850,000 1,375
Obstetric Adverse Events .0015 $171,000,000 84
Pressure Ulcers .072 $1,062,500,000 4,525
Surgical Site Infections .028 $161,700,000 217
Ventilator-Associated Pneumonias .144 $210,000,000 1,438
(Post-op) Venous Thrombo-Embolisms .104 $160,000,000 2,080
All Other HACs .045 $4,544,100,000 12,109
Totals NA $9,141,150,000 35,647

 

Return to Contents


7. 2010 baseline data is online at: http://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html#methods.

8. Abstract is available at: http://www.ncbi.nlm.nih.gov/pubmed/25119788.

9. In 2011, this work was completed using the best available information to generate 2010 incidences and other information regarding the HACs. The sources of the estimates 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, as well as expert opinions. 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.

Page last reviewed November 2015
Page originally created November 2015
Internet Citation: Appendix: Incidence of Hospital-Acquired Conditions in the Partnership for Patients: Estimates and Projected and Measured Impact. Content last reviewed November 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhac2014-ap1.html