Becker's Clinical Quality & Infection Control

34 QUALITY IMPROVEMENT & MEASUREMENT CMS issues final rule on discharge planning: 3 things to know By Mackenzie Bean C MS finalized a rule Sept. 26 that revises discharge planning re- quirements for hospitals. Three things to know: 1. Under the rule, hospitals must focus on patients' care goals and treatment preferences during the discharge planning process. 2. Hospitals must assist patients in selecting a post-acute provider by sharing relevant quality performance data for post-acute facilities, including readmission and patient fall rates. 3. The rule also requires hospitals to ensure each patient has access to an electronic version of their medical records. "Today's rule is huge step to providing patients with the ability to make healthcare decisions that are right for them and gives them transparency into what used to be an opaque and confusing process," CMS Administrator Seema Verma said in a news release. "Patients will now no longer be an afterthought; they'll be in the driver's seat, play- ing an active role in their care transitions to ensure seamless coordina- tion of care." n CAUTI reporting guidelines inflate hospitals' performance, study suggests By Gabrielle Masson C hanges in national reporting guidelines for catheter-associat- ed urinary tract infections have significantly improved hos- pitals' infection ratios since 2015, which offers an inaccurate depiction of quality performance unrelated to patient outcomes, according to a study published Sept. 16 in Infection Control and Hospital Epidemiology. CAUTIs are tracked as part of federal value-based incentive programs implemented in 2015. Researchers from Boston University School of Medicine analyzed data reported by 592 hospitals to the CDC, finding that CAUTI rates decreased by 42 percent when the incentive pro- grams were implemented. "While this may seem like an effect of the programs, the large decline [in] CAUTI rates was actually due to a concurrent change in which infections 'count' as CAUTI," co-author Heather Hsu, MD, assistant pro- fessor of pediatrics at Boston University, told Medical Express. After the guideline revision, more hospitals had favorable standard- ized infection ratios. "The case of CAUTI is an illustration of how measurement changes can not only impact evaluations of hospital performance but also potentially lead to inappropriate assessments of financial rewards or penalties that do not reflect meaningful differences in patient safety or hospital performance," Dr. Hsu told Medical Express. n NYU Langone Health taps Amazon, Google tactic for quality improvement By Anuja Vaidya N YU Langone Health in New York City suc- cessfully used randomized quality improve- ment projects to evaluate the effectiveness of routine patient care processes. e team that implemented the projects report- ed their findings in e New England Journal of Medicine. Companies in the private sector, such as Google and Amazon, oen use randomized continuous quality improvement methods in their workflow; however, it is not yet common in the healthcare sector yet. At NYU Langone, randomized quality improve- ment projects were implemented across its inpatient units, outpatient offices and the emergency depart- ment, focusing on improving care aer hospital stays and capturing patient-reported outcomes, among others. e randomized quality improvement projects test- ed many processes, allowing NYU Langone to make tweaks as needed. For example, one of the projects tested the effectiveness of post-discharge phone calls to patients. It showed that the phone calls were ineffective because patients who received the calls came back to the hospital at the same rate as those who didn't get the calls. e findings allowed the team to explore other options for more effective post-discharge follow-up, such as changing the call script or only calling high- risk patients. e randomized quality improvement projects were designed to be easy to implement, said Leora Horwitz, MD, an associate professor at NYU Langone's departments of population health and medicine, director of the Center for Healthcare Innovation and Delivery Science and leader of the projects. e projects do not require specialized tools or databases. "I believe we have an ethical responsibility to rigorously assess whether our operational interven- tions are effective, even when they may seem trivial, such as scripts for calls or mailings that we send to people to get them to get their colonoscopy," Dr. Horwitz said. "If we don't, we can't be sure we are doing the best by our patients." n

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