Introduction
The attention on Hospital-Acquired Conditions (HACs) can date back to
more than 40 years ago in the USA, and the definition is harmful
secondary events occurring in a hospital setting during a patient’s
evaluation or treatment 1. HACs not only result in
extra medical resource but also increase an individual’s financial
burden and medical insurance waste. Prolonged hospitalization, usually
for parenteral antibiotic treatment, accounts for more than
three-fourths of this cost 2. The delayed discharge
also increases the risk of additional harm whether physically or
psychologically, and sometimes is even unrelated to the original reason
for hospitalization. From the point of view of the doctor-patient
relationship, the newly occurring diseases during patients’
hospitalization could lead a tense situation and become the fuse of
doctor-patient disputes.
Many countries in the USA carried out multiple kinds of research on this
HACs 3. According to the famous Harvard medical
practice study, adverse events occurred in 3.7% of the
hospitalizations, most of the adverse events gave rise to disability
lasting less than 6 months, and 2.6% caused permanently disabling
injuries and 13.6% led to death. However, 27.6% of the adverse events
were due to negligence 4. Some researches pointed out
specific medical problems and analyzed the risk factors. On the problem
of nonpayment after total joint arthroplasty, Kyle R et al. found that
nearly 70 million dollars’ hospital costs would be lost annually on the
HAC after receiving this surgery 5. Except for the
discovery of economic waste, HACs can be considered as an observable
indicator to provide a chance to find out the factors of both sides,
which can predict the development and benefit patients and doctors. For
example, J. Cromarty et al. reported diabetes patients with end-organ
sequelae have increased length of stay6, which
emphasized the importance of manifestations for glycemic control. All
those conclusions can remind us of the sense of HACs, and guide us to
specify response policies to realize the functions of hospitals
directionally.
In Australia, HACs are used as monitoring indicators for hospital
medical quality, patient safety and medical management6. The paying for The Centers for Medicare and
Medicaid Services (CMS) has been moved from the volume of services they
provide to the quality of those services (the latter is known as the
pay-for-performance model), and they focused on improving care quality
in acute care hospitals by these programs: the Hospital Value-Based
Purchasing (HVBP) program, the Hospital Readmission Reduction Program
(HRRP), and the HAC reduction program 1. As a
pay-for-performance initiative, the CMS nonpayment policy is intended to
improve the quality of care to reduce HACs and decline unnecessary
health care expenditures 8. However, what calls into
question are the validity of the HACRP and its risk adjustment, due to
the sensitivity of the HACRP penalties to small changes in performance
and the correlation of the HACRP score with hospital characteristics9. The policies on HACs still need consistent
improving.
At present, most ideas, from the point of hospital infection, nursing,
and adverse drug reactions to report the HACs, were proposed by doctors
or nurses. There is a lack of systematic viewpoint of medical care,
patient safety and management of HACs from the medical administrator in
China. Strengthening the analysis, research, and management of HACs has
become one of the most important works in international hospitals. To
implement the research and management of HACs in China, the previous
Ministry of Public of China asked to enable a new medical record
homepage and heavily commented “present on admission (POA)”. They
suggested that we should enhance medical stuff’s recognition of HACs by
filling and attaching importance to the condition of admitted patients
to improve the quality of medical work, ensure patients’ safety, and
reduce the waste of medical resources. But because of little emphasis,
this project brought little effect. We retrospect the events of HACs in
all in-hospital patients in our hospital from 2016 to 2018, compared the
incidence rate, basic characters of patients, the financial costs, and
the length of hospitalization in order to find the underlying trend of
patterns to explain the reason and improve the medical service and
medical management.