Date of Award

2017

Embargo Period

8-1-2024

Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Jillian B. Harvey

Second Advisor

Lt. Col. Candy Wilson

Third Advisor

J. Allen Kent

Fourth Advisor

James S Zoller

Abstract

Background: The greatest healthcare cost in the United States, that is not insurance related, are attributable to the complications developed due to preventable infections. The standard fee-for-service approach is changing to pay-for-performance requiring quality over quantity by healthcare providers. There is a growing sense that Americans spend too much on healthcare for too little value (Kane & Radosevich, 2011). People demand better quality in their healthcare delivery, and healthcare organizations are finding themselves focusing on quality and emphasizing patient-centeredness. Healthcare organizations are aiming to become zero-harm, just-cultured, high reliability organizations (HROs). Health policy in the United States is following suit by implementing strict payment criteria. Under section 5001(c) of the Deficit Reduction Act of 2005, Medicare, our country’s longest standing healthcare legislation, will no longer reimburse payment for a specific set of hospital-associated complications (Kane & Radosevich, 2011). Section 5001 (c) targets hospital quality improvement with particular attention to quality adjustments in diagnosis-related group (DRG) payments for certain hospital acquired infections (HAI). The section requires the secretary of the Centers for Medicare and Medicaid Services (CMS) to classify hospital-acquired conditions (HACs) as follows: (a) are high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines (CMS, 2016). Not all HAC categories are germane to HAIs. The general list of HACs generated by the CMS relevant to HAIs include catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs). Also on the list are various surgical site infections (SSIs) including mediastinitus following coronary artery bypass graft (CABG), certain orthopedic procedures, and SSIs following bariatric surgery for obesity and cardiac implantable device (CIED) procedures (CMS, 2016). Currently, the CDC has a simple a simple list of recommendations to combat these issues (Centers for Disease Control, 2016). Emergence of MRSA: MRSA is a primary organism of interest for comparative effectiveness research (CER) studies due to its high threat to the quality of healthcare (Wassenberg, et al., 2012). Historically, MRSA was described shortly after the introduction of methicillin but was uncommon outside the health care environment until the 1990s. Around that time, reports emerged of patients presenting with MRSA infections who did not have traditional health care risk factors. These reports included both children and adults in various geographic locations predominately presenting with SSTI, with community clusters among athletes, men who have sex with men, correctional facilities, homeless persons, military personnel, and indigenous populations (Tong, Davis, Eichenberger, Holland, & Fowler, 2015). Due to the impact of HAIs caused by MRSA, the Institute of Medicine (IOM) has made this CER topic a top priority under the American Recovery and Reinvestment Act of 2004 (IOM, 2009). HAIs triggered by methicillin-resistant Staphylococcus aureus (MRSA) have long been associated with increased mortality and burdensome health care costs (Wassenberg et al., 2012). MRSA is one of the most prominent causes of HAC related complications targeted by the CMS. To ensure better outcomes, more research is needed to compare the effectiveness of various screening, prophylaxis, and treatment interventions in eradicating MRSA in communities, institutions, and hospitals. Many published studies address the problem with MRSA HAIs, as well as the various approaches to infection control techniques and patient risk factors associated with colonization of MRSA.

Rights

All rights reserved. Copyright is held by the author.

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