Impact of Quality Improvement Support on Hospital Readmissions and Patient Safety Outcomes: A Quasi-Experimental Study of a National Quality Improvement Initiative

BackgroundThe Centers for Medicare & Medicaid Services (CMS) administers the Hospital Quality Improvement Contractor (HQIC) program to improve healthcare quality and safety in hospitals serving Medicare beneficiaries. These contractors provided technical assistance to small, rural hospitals, and/or to hospitals with lower quality ratings. This study aimed to evaluate the programs effectiveness in addressing two priority areas: reducing hospital readmissions and increasing patient safety. MethodsA quasi-experimental design was used to assess the impact of HQIC support on 30-day all-cause readmissions and eight patient safety outcomes in hospitals that received support between October 1, 2020, and December 31, 2023 (N = 1,929). Patient safety outcomes included adverse drug events (ADEs) and healthcare-associated infections (HAI). A difference-in-difference model specification with a Poisson generalized estimating equation was used to compare hospitals receiving support for each outcome to matched hospitals that did not receive HQIC support. ResultsReceiving HQIC support was associated with a 1.4% reduction in the number of 30-day all-cause readmissions compared to hospitals with similar characteristics that did not receive HQIC support for readmissions. Hospitals receiving HQIC support for reducing catheter-associated urinary tract infections (CAUTI) showed a 17.4% reduction in the number of CAUTI events relative to hospitals that did not receive support. There was no statistically significant effect on the other outcomes. ConclusionsThe HQIC program support had an impact on reductions in hospital readmissions and reductions for one of the HAIs but not on other patient safety outcomes. These findings suggest a targeted approach in resource allocation may improve readmissions and CAUTI rates for small and rural hospitals. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIHospital readmissions, adverse drug events in inpatient care, and healthcare-associated infections increase morbidity and mortality and are costly to the healthcare system, and evidence-based strategies exist to help reduce these events. C_LIO_LIThe Centers for Medicare & Medicaid Services implemented a national quality improvement initiative that provides training and technical assistance to hospitals, particularly to small and rural hospitals, to reduce readmissions and improve patient safety outcomes. C_LI What this study addsO_LIThis study provides the opportunity to examine the impact of a national quality improvement effort on hospital readmissions and patient safety outcomes. Quality improvement support was associated with significant reductions in hospitals 30-day all-cause readmissions and catheter-associated urinary tract infections, but not with other patient safety indicators assessed. C_LI How this study might affect research, practice or policyO_LIThe finding that quality improvement support to hospitals resulted in improved outcomes suggests the need for prioritization and investment in this approach. C_LIO_LIThe limited program impact on improving rare outcomes highlights the importance of aligning goals with the unique needs of smaller, rural hospitals in the design of future quality improvement programs. C_LI