糖心vlog

Metersky et al¹ present compelling evidence that adverse events (AEs), including medication errors and hospital-acquired infections (HAIs), increased among patients both with and without COVID-19 during weeks in which hospitals experienced greater COVID-19 admission burdens during the COVID-19 pandemic. The risk of AEs increased 9% with each 10% increase in COVID-19 burden, defined as the daily mean number of COVID-19 inpatients per 100 hospital beds. The investigation by Metersky et al¹ improved on the methods of existing work through its use of hospital-specific COVID-19 admissions data (rather than regional or aggregate hospital data) from the US Department of Health and Human Services (HHS) and its reliance on systematically adjudicated AEs from the Agency for Healthcare Research and Quality. The authors concluded with the recommendation to build more resilient systems of care to maintain patient safety during times of surge capacity. Indeed, these conclusions are well supported by the authors鈥� approach and analysis, and this represents a public health call to action in the US to avoid excess morbidity and mortality in the future.

However, still absent from the peer-reviewed literature is a discussion of the importance of hospital quality performance reporting and benchmarking in times of crisis as a mechanism to ensure safety. Hospitals in the US were effectively relieved of their obligations to provide high-quality pandemic-era care when pay-for-performance programs,² rankings,³ and ratings⁴ excluded months of pandemic-era data from their methods. Though ostensibly made with benign intent, these decisions to exclude pandemic-era quality-reporting data were not patient centered and may not have been methodologically necessary.^5,6 The findings of Metersky et al¹ demonstrate that quality and safety data are needed more than ever during times of crisis. This would allow patients and payers to understand which hospitals have resilient systems in order to make informed decisions about where they choose to receive and fund health care.

For example, while Metersky et al¹ found only small differences in fall rates for patients without COVID-19 across hospitals with varying COVID-19 burden, a dose-response association was observed between increasing COVID-19 burdens and HAIs. We may therefore infer differences in systems and processes for fall prevention that allowed for greater resilience than systems and processes for prevention of HAIs. Logically, we could then consider whether exclusion of pandemic-era falls data from hospital-quality reporting was necessary. Exploring these nuances will be critical to identify where resilience in safety is lacking and to build resilience for the future. This may require the creation of pandemic-specific resilience action plans and self-reporting requirements by accrediting bodies, analogous to recent Joint Commission requirements for the reduction of health care disparities. Individual hospitals almost certainly varied in the specific domains of quality that were most and least resilient during the pandemic. Each hospital鈥檚 least resilient system may represent low-hanging fruit or a starting point for building resilience. To date, however, finding these opportunities to build resilience has been a difficult task, in part due to the exclusion of pandemic-era benchmarking data.

Ask chief quality officers to select any 3 among the hundreds of publicly reported quality measures (30-day readmissions, 30-day mortality, falls, HAIs, pressure ulcers, and so on) at which they believe their institution performed the worst during the pandemic, and you will likely get dozens of different answers. For many, the most truthful answer may be 鈥淚 do not know,鈥� which hinders the ability to prioritize improvement. For example, if you knew that the 30-day hospital-wide readmissions rate had dropped from the 90th percentile of national performance to the 20th percentile of performance during the pandemic, there would be an important opportunity to consider which aspects of resilience specific to readmissions at your institution required improvement.

With hospital-specific COVID-19 admissions data from HHS coupled with patient-level Medicare or other electronic health record or claims data, it is still possible to recreate the unreported pandemic-era quality outcomes benchmarks to identify resilient hospitals, systems, and processes during surge capacity. In fact, the Centers for Medicare & Medicaid Services鈥� FY 2025 Inpatient Prospective Payment System Proposed Rule will extend the COVID-19 admissions data to include data for all respiratory illnesses. This will allow for the inclusion of future pandemic-era data in quality reporting using risk adjustment for hospitals鈥� respiratory illness admission burdens rather than excluding months or years of data.

At the onset of the pandemic, many assumed that COVID-19 would have devastating implications for hospital quality.⁷ We neglected our patients, payers, and communities by choosing not to fully report these outcomes through established hospital-quality reporting programs during the pandemic. We will amplify this neglect if we choose to ignore specific failures and successes in hospital-quality resilience during the pandemic. This neglect will translate to harm when the next health system crisis arrives and we have not used lessons learned from COVID-19 to bolster our resilience.

Published: November 4, 2024. doi:10.1001/jamanetworkopen.2024.42944

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Pollock BD et al. 糖心vlog Open.

Corresponding Author: Benjamin D. Pollock, PhD, MSPH, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (Pollock.Benjamin@Mayo.edu).

Conflict of Interest Disclosures: None reported.