USA: Care quality, safety 'worse than expected' during Covid-19 pandemic

A new CMS report reveals disparities in care quality and patient safety within US hospitals before and during the pandemic, finding "a large proportion of measures had worse than expected performance." 

CMS released its 2024 National Impact Assessment Feb. 28, which is released every three years and evaluates the measures used in 26 CMS quality and value-based incentive payment programs. This edition of the report compares quality measure scores pre-COVID-19 with hospitals' results in 2020 and 2021, the initial years of the COVID-19 public health emergency. 

Here are eight findings from the 72-page assessment:

1. During 2020 and 2021, a large proportion of measures had worse than expected performance, including significant worsening of key patient safety metrics.

2. Half or more of the performance measures in five priorities had worse results in 2021 than expected from the 2016–2019 baseline. Priorities with the highest proportions of worse-than-expected results in 2021 were wellness and prevention (69%), behavioural health (55%), safety (54%), chronic conditions (52%), and seamless care coordination (50%). 

3. Specific to safety, standardised infection ratios worsened significantly in hospitals for central line–associated bloodstream infections (94% worse), MRSA (55% worse) and CAUTI (34% worse). Before the Covid-19 PHE (2015–2019), 34,455 fewer healthcare-associated infections (HAIs) were reported in acute care settings. 

4. More than 35% of measures in two priorities had better results in 2021 than expected from 2016–2019 baseline trends. Those priorities are seamless care coordination (50%) and affordability and efficiency (38%). 

5. Specific to affordability and efficiency, emergency department visits for home health patients fared 1.4 percentage points better, and acute care hospitalization in the first 60 days of home health in 2021 was 1.5 percentage points better. 

6. Accountable entities with the highest proportions of worse than expected results in 2021 were clinicians (64%), accountable care organizations (54%), and acute care facilities (54%). 

7. Wellness and prevention had the highest percentage of measures showing health equity disparities; notable examples include pneumococcal and influenza vaccinations among racial and ethnic groups.

8. Comparison racial and ethnic groups fared worse than the White reference group on 40 of 45 (88.9%) affordability and efficiency measures and 32 of 41 (78%) chronic conditions measures. For example, disparities were recorded for Black or African American patients in 32, or 71%, of the affordability and efficiency measures, mostly related to readmissions.

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Source: Becker Hospital Review, 29 February 2024