Experts refute results of CMS patient safety program

Although the Centers for Medicare & Medicaid Services (CMS) boasts patient safety improvements through its Partnership for Patients program (PPP), an opinion piece in the New England Journal of Medicine questions whether the initiative actually improved patient care.

The program's weak study design and methods, in addition to a lack of transparency and rigor in evaluation, make it difficult for healthcare organizations to learn from improvement efforts and stifles progress toward a safer, more effective healthcare system, write Peter Pronovost, M.D., Ph.D, senior vice president for patient and safety and quality, Johns Hopkins Medicine and Ashish K. Jha, M.D., M.P.H., professor of health policy and management at the Harvard School of Public Health.

The public-private program was established under the Affordable Care Act in December 2011 as a collaboration of 26 hospital engagement networks (HENs) that represented more than 3,700 hospitals in an effort to reduce hospital-acquired conditions by 40 percent and 30-day readmissions by 20 percent nationwide by the end of 2013.

CMS announced in February that the rates of early elective deliveries dropped by 48 percent among 681 hospitals in 20 networks and the national rate of all-cause readmissions dropped from 19 percent to 17.9 percent. The authors write that the numbers appear impressive, but it's nearly impossible to determine whether the initiative led to better care given the publicly available data and the approach CMS used.

Pronovost and Jha say that the main problems with CMS' evaluation are that it used a pre-post design with only single points in the pre- and post- period and didn't have concurrent controls. The result, they say, is highly subject to bias.

Furthermore, CMS didn't use a standardized and validated performance measures across all participating hospitals, the authors claim. Instead, the agency allowed each HEN to define its own performance measures and didn't focus on data quality control.

It also didn't subject the work to independent evaluation or peer review. Had it done so, Pronovost and Jha write that CMS might have changed its evaluation plan or provided more data.

The PPP required thousands of hours of clinicians' time and large sums of money, making the lack of confidence in the results "particularly unfortunate," they write. "More important, the failure to generate valid, reliable information hampers our ability to improve future interventions, because we are no closer to understanding how to improve care than we were before the PPP. And that is the biggest cost of all."

To learn more:
- read the NEJM piece
- read CMS blog post

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