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Slawomirski L, Hensher M, Campbell J, deGraaff B. Pay-for-performance and patient safety in acute care: A systematic review. Health Policy 2024; 143:105051. [PMID: 38547664 DOI: 10.1016/j.healthpol.2024.105051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/20/2024]
Abstract
Pay-for-performance (p4p) has been tried in all healthcare settings to address ongoing deficiencies in the quality and outcomes of care. The evidence for the effect of these policies has been inconclusive, especially in acute care. This systematic review focused on patient safety p4p in the hospital setting. Using the PRISMA guidelines, we searched five biomedical databases for quantitative studies using at least one outcome metric from database inception to March 2023, supplemented by reference tracking and internet searches. We identified 6,122 potential titles of which 53 were included: 39 original investigations, eight literature reviews and six grey literature reports. Only five system-wide p4p policies have been implemented, and the quality of evidence was low overall. Just over half of the studies (52 %) included failed to observe improvement in outcomes, with positive findings heavily skewed towards poor quality evaluations. The exception was the Fragility Hip Fracture Best Practice Tariff (BPT) in England, where sustained improvement was observed across various evaluations. All policies had a miniscule impact on total hospital revenue. Our findings underscore the importance of simple and transparent design, involvement of the clinical community, explicit links to other quality improvement initiatives, and gradual implementation of p4p initatives. We also propose a research agenda to lift the quality of evidence in this field.
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Affiliation(s)
- Luke Slawomirski
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart 7000, Tasmania, Australia.
| | - Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart 7000, Tasmania, Australia
| | - Julie Campbell
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart 7000, Tasmania, Australia
| | - Barbara deGraaff
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St., Hobart 7000, Tasmania, Australia
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Abasi U, Okello Damoi J, Turumanya Kalumuna A, Giibwa A, Park S, Cuva D, Yu AT, Emoru A, Bakaleke Binoga M, Villavisanis D, Kiani SN, Glerum K, Waye J, Marin M, Zhang L. Ambulatory Surgery Center in Rural Uganda: A Novel Approach to Providing Surgical Care. Cureus 2024; 16:e55848. [PMID: 38590474 PMCID: PMC11001256 DOI: 10.7759/cureus.55848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite evidence that ambulatory surgery is safe with faster recovery compared to in-patient hospitalization, surgeons in low- and middle-income countries like Uganda have been hesitant to embrace this practice. Kyabirwa Surgical Center (KSC) is the first freestanding ambulatory surgery center (ASC) in rural Uganda. We aim to report the impact of a rural ASC since its establishment, in alleviating surgically-treatable morbidity within its catchment area. METHODS KSC is located in Jinja, Uganda. The center's electronic medical record was used to analyze the utilization of services, and the Uganda Bureau of Statistics was used to calculate KSC's catchment area. Effectiveness was calculated using disability-adjusted life years (DALYs) averted. RESULTS Between July 2019 and December 2021, 7,391 patients (57.7% female, 42.3% male) visited KSC from a catchment area of 570,790 people. Of 1,355 procedures, 64.6% were general surgery, 21.3% endoscopy, 9.2% gynecological/genitourinary), 2.8% ENT, 1.5% colorectal, and 0.6% orthopedics. There were no postoperative hospital admissions for complications or mortalities. From the seven most common procedures with an associated disability weight, 2,193.16 total DALYs were averted. CONCLUSION ASCs can be effective in addressing surgical care gaps in Uganda by increasing the yearly surgical capacity of the local catchment area and averting DALYs within the population.
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Affiliation(s)
- Unwana Abasi
- Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | | | - So Park
- Surgery, Mount Sinai Hospital, New York, USA
| | - Dylan Cuva
- Surgery, Mount Sinai Hospital, New York, USA
| | - Allen T Yu
- Surgery, Mount Sinai Hospital, New York, USA
| | - Arthur Emoru
- Anesthesiology, Kyabirwa Surgical Center, Jinja, UGA
| | | | - Dillan Villavisanis
- Plastic and Reconstructive Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Sara N Kiani
- Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Jerome Waye
- Gastroenterology, Mount Sinai Hospital, New York, USA
| | | | - Linda Zhang
- Surgery, Mount Sinai Hospital, New York, USA
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Shenoy A, Shenoy GN, Shenoy GG. The US hospital-acquired condition reduction program: A linear and logistic regression analysis of domains and penalty status. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2065619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Amrita Shenoy
- College of Public Affairs, School of Health and Human Services, Healthcare Administration and Management Program, University of Baltimore, Baltimore, MD, USA
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Hamadi H, Borkar SR, Moody L, Tafili A, Wilkes JS, Moreno Franco P, McCaughey D, Spaulding A. Hospital-Acquired Conditions Reduction Program, Patient Safety, and Magnet Designation in the United States. J Patient Saf 2021; 17:e1814-e1820. [PMID: 32217925 DOI: 10.1097/pts.0000000000000628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the association between hospitals' nursing excellence accreditation and patient safety performance-measured by the Hospital-Acquired Conditions Reduction Program (HACRP). METHODS We linked data from the American Nursing Credentialing Center Magnet Recognition Program, Centers for Medicare and Medicaid Services HACRP, and the American Hospital Association annual survey from 2014 to 2016. We constrained the analysis to hospitals participating in Centers for Medicare and Medicaid Services' HACRP and deployed propensity score matching models to calculate the coefficients for our HACRP patient safety measures. These measures consisted of (a) patient safety indicator 90, (b) hospital-associated infection measures, and (c) total HAC scores. In addition, we used propensity score matching to assess HACRP scores between hospitals achieving Magnet recognition in the past 2 versus longer and within the past 5 years versus longer. RESULTS Our primary findings indicate that Magnet hospitals have an increased likelihood of experiencing lower patient safety indicator 90 scores, higher catheter-associated urinary tract infection and surgical site infection scores, and no different total HAC scores. Finally, when examining the impact of Magnet tenure, our analysis revealed that there were no differences in Magnet tenure. CONCLUSIONS Results indicate that the processes, procedures, and educational aspects associated with Magnet recognition seem to provide important improvements associated with care that is controlled by nursing practice. However, because these improvements do not differ when comparing total HAC scores nor Magnet hospitals with different tenure, there are likely opportunities for Magnet hospitals to continue process improvements focused on HACRP scores.
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Affiliation(s)
- Hanadi Hamadi
- From the Department of Health Administration, Brooks College of Health, University of North Florida
| | - Shalmali R Borkar
- Department of Health Sciences Research, Division of Health Care Policy, and Research, Mayo Clinic Robert D., and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic
| | - LaRee Moody
- Bachelor of Health Administration Program, Books College of Health, University of North Florida
| | - Aurora Tafili
- From the Department of Health Administration, Brooks College of Health, University of North Florida
| | - J Scott Wilkes
- From the Department of Health Administration, Brooks College of Health, University of North Florida
| | | | - Deirdre McCaughey
- Department of Community Health Sciences Affiliate, W21C Research and Innovation Centre, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aaron Spaulding
- Department of Health Sciences Research, Division of Health Care Policy, and Research, Mayo Clinic Robert D., and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic
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