Samuel K. Peasah,1Niccie L. McKay,2Jeffrey S. Harman,2Mona Al-Amin,3Robert L. Cook4
1Mercer University—College of Pharmacy 2University of Florida—Department of Health Services Research, Management, and Policy 3Suffolk University—Sawyer Business School 4University of Florida—Department of Epidemiology
Background: Medicare ceased payment for some hospital-acquired infections beginning October 1, 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. Objective: We examined the association of this policy with declines in rates of vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infection (CAUTI). Data: Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011. Study Design: We compared rates of hospital-acquired vascular catheter-associated infections (HA-VCAI) and catheter-associated urinary tract infections (HA-CAUTI) before and after implementation of the new policy (January 2007 to September 2008 vs. October 2008 to September 2011). This pre-post, retrospective, interrupted time series study was further analyzed with a generalized hierarchical logistic regression, by estimating the probability of a patient acquiring these infections in the hospital, post-policy compared to pre-policy. Principal Findings: Pre-policy, 0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Similarly, 0.24% of admissions were diagnosed as VCAI; of these, 60% were HA-VCAI. Post-policy, 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI. Similarly, 0.3% of admissions were VCAIs and, of these, 45% were HA-VCAI. There was a statistically significant decrease in HA-VCAIs (OR: 0.571 (p<0.0001)) post-policy, but the reduction in HA-CAUTI (OR: 0.968 (p<0.4484)) was not statistically significant. Conclusions: The results suggest Medicare non-payment policy is associated with both a decline in the rate of hospital-acquired VCAI (HA-VCAI) per quarter, and the probability of acquiring HA-VCAI post- policy. The strength of the association could be overestimated, because of concurrent ongoing infection control interventions.