Introduction: The Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) and the Agency for Healthcare Research and Quality patient safety indicators (PSIs) are standardized quality metrics linked to reimbursement. Spontaneous intracerebral hemorrhage (ICH) is associated with a poorer prognosis than other types of stroke. The incidence, risk factors, and in-hospital outcomes associated with HACs and PSIs in ICH admissions have not previously been reported.
Methods: The Nationwide Inpatient Sample was queried from 2002 to 2011 to identify all ICH patients (ICD-9-CM code 431). The incidence of HACs and PSIs was determined. Multivariable logistic regression analyzed the effect of patient and hospital factors on HAC/PSI occurrence and the effect of HAC/PSI occurrence on prolonged length of stay (defined as ≥ 75th percentile), increased hospital costs (defined as ≥75th percentile), and adverse discharge (except routine).
Results: A total of 12,870 HACs and 260,048 PSIs were identified among 643,660 hospitalizations for spontaneous ICH. The HACs with the highest incidence were falls/trauma (n=1,198), postoperative poor glycemic control (n=895), stage III/IV pressure ulcers (n=622), and iatrogenic pneumothorax (n=620). The PSIs with the highest incidence were postoperative respiratory failure (n=194,859), postoperative sepsis (n=19,045), pressure ulcer (n=17,826), and deep vein thrombosis (n=15,759). Comorbidity score (19.7%, 18.9% increase per comorbidity, p<0.0001) and Medicaid insurance (31.5%, 21.4%, p<0.0001) were independent predictors of HAC and PSI occurrence, respectively. Black race (15.7%, p<0.0001), urban hospitals (69%, p<0.0001), and teaching hospitals (35.2%, p<0.0001) were independent predictors of PSI occurrence only. Both HAC and PSI occurrence increased the odds of prolonged LOS (64.9%, 36.9%, p<0.0001), increased hospital costs (70.8%, 72.9%, p<0.0001) and adverse discharge (32%, 167.1%, p<0.0001).
Conclusion: HACs and PSIs occur frequently in ICH hospitalizations and are associated with poor in-hospital outcomes. Awareness of the factors that increase the likelihood of incurring HACs and PSIs may contribute to new quality protocols targeted at these factors.