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Comment & Response |

Ongoing Attention to Injurious Inpatient Falls and Pressure Ulcers

Joanne Spetz, PhD1; Diane S. Brown, PhD, RN2,3; Carolyn S. Aydin, PhD3,4
[+] Author Affiliations
1Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
2Kaiser Permanente Northern California, Oakland
3Collaborative Alliance for Nursing Outcomes (CALNOC), San Ramon, California
4Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
JAMA Intern Med. 2015;175(9):1580-1581. doi:10.1001/jamainternmed.2015.2549.
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To the Editor The effectiveness of Centers for Medicare & Medicaid Services (CMS) performance-based payment strategies will shape efforts to improve the quality and value of care. Waters et al1 examined the effect of the Hospital-Acquired Conditions (HACs) Initiative, which denies incremental payment for 8 complications on 4 outcomes: central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. They found an association with reductions in CLABSIs and CAUTIs but not injurious falls or stage III/IV HAPUs. Waters et al concluded that there is less evidence that changing hospital processes affects these other 2 outcomes, but we believe this conclusion may be missing key factors.

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September 1, 2015
Grace M. Lee, MD, MPH; Stephen B. Soumerai, ScD; for the Preventing Avoidable Complications by Adjusting Payment (PAICAP) Study Team
1Harvard Medical School, Boston, Massachusetts2Harvard Pilgrim Health Care Institute, Boston, Massachusetts
JAMA Intern Med. 2015;175(9):1581-1582. doi:10.1001/jamainternmed.2015.2552.
September 1, 2015
Teresa M. Waters, PhD; Michael J. Daniels, ScD; Gloria J. Bazzoli, PhD; for the Hospital Responses to Medicare’s Nonpayment for Preventable Complications (HRMNPC) Team
1Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
2Department of Statistics & Data Sciences, The University of Texas at Austin, Austin3Department of Integrative Biology, The University of Texas at Austin, Austin
4Department of Health Administration, Virginia Commonwealth University, Richmond
JAMA Intern Med. 2015;175(9):1582. doi:10.1001/jamainternmed.2015.2568.
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