{"title":"Quality control efforts of medical institutions: the impacts of a value-based payment system on medical staff and healthcare-associated infections","authors":"K-T. Han , S. Kim , G.O. Kim , S. Lee , Y.U. Kwon","doi":"10.1016/j.jhin.2024.06.021","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Aim</h3><p>To evaluate the impact of quality management efforts of medical institutions on securing medical staff and healthcare-associated infections in intensive care units (ICUs).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"153 ","pages":"Pages 3-13"},"PeriodicalIF":3.9000,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hospital Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0195670124002603","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
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.
期刊介绍：
The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.
The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that:
provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings;
provide new insight into cleaning, disinfection and decontamination;
provide new insight into the design of healthcare premises;
describe novel aspects of outbreaks of infection;
throw light on techniques for effective antimicrobial stewardship;
describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control;
improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change;
improve understanding of the use of IT systems in infection surveillance and prevention and control.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
