Quality control efforts of medical institutions: the impacts of a value-based payment system on medical staff and healthcare-associated infections.

Autor: Han KT; Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Centre, Goyang, Republic of Korea., Kim S; Department of Health System, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea; Research Institute for Hospice/Palliative Care, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: seungju.phd@gmail.com., Kim GO; Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea., Lee S; Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea., Kwon YU; Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2024 Nov; Vol. 153, pp. 3-13. Date of Electronic Publication: 2024 Jul 31.
DOI: 10.1016/j.jhin.2024.06.021
Abstrakt: Background: In South Korea, various quality assessments have been introduced to improve the quality of care; as such, the overall level of quality of medical institutions has improved. However, gaps still exist between institutions.
Aim: To evaluate the impact of quality management efforts of medical institutions on securing medical staff and healthcare-associated infections in intensive care units (ICUs).
Methods: This study used data from the second and third ICU quality assessments conducted by the Health Insurance Review and Assessment Service, which included 265 hospitals and 39,096 inpatients. The continuous quality improvement efforts of medical institutions were measured according to changes in their grade based on quality assessment results. In addition, healthcare-associated infection rates were measured, including rates for ventilator-associated pneumonia and catheter-associated infections. The incidence rate ratio (IRR) was calculated using generalized estimating equation Poisson regression models that included hospital and patient characteristics.
Results: Healthcare-associated infections occurred in approximately 2% of patients using ventilators or catheters. Ventilator-associated pneumonia increased significantly in institutions with a decline in grade [IRR 2.038, 95% confidence interval (CI) 1.426-2.915]. In institutions with an improvement in grade, infections associated with central venous catheters (IRR 0.484, 95% CI 0.330-0.711) and urinary catheters (IRR 0.587, 95% CI 0.398-0.866) decreased.
Conclusions: Although quality assessment has been introduced in ICUs in South Korea, some gaps remain between medical institutions. Differences in securing medical resources through the quality management efforts of medical institutions were observed, and the infection rate was low in hospitals with high-quality management and high in hospitals with low-quality management.
(Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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