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.