Date of Award

Fall 8-2019

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

CHARLES BEGLEY, PHD

Second Advisor

JAMES LANGABEER, ED, PHD, FACHE

Third Advisor

SUJA S RAJAN, MHA, MS, PHD

Abstract

In 2012, the Centers for Medicare and Medicaid Services (CMS) launched the Hospital Engagement Network (HEN) program to decrease patient harm events in United States’ (US) hospitals. The HEN program became the nation’s largest quality improvement collaborative (QIC) focusing on improving patient care. Results from the program’s formal evaluation were inconclusive on whether the HEN program was effective. There have been no other known studies on this program’s effectiveness. Even with the evidence lacking, the CMS continues to fund programs similar to the HEN program. This study’s research aim was to compare patient outcomes for HEN participants to nonparticipants to evaluate the program’s performance.

The sample contained US hospitals with at least 25 beds and reported outcome data to Hospital Compare. A retrospective comparative analysis was performed on central line associated bloodstream infection (CLABSI) standardized infection ratios (SIRs) and 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. In both articles, pre-post trends were analyzed using fixed effects regression models to control for hospital characteristics and baseline performance.

For the first study, there were a total of 7,632 hospital years of data between HEN participants (6,374) and nonparticipants (1,258). The fixed effects regression model indicated that HEN participation did not reduce the CLABSI SIR in participating hospitals (p=.816). When the sample was divided into three groups based on baseline performance, the HEN participation coefficient (-.085) was moderately significant (p=.079) for the high performing group (lowest average CLASBI SIR in 2011). For the other two groups, medium (p=.960) and low performance (p=.848), the HEN participating coefficient was not significant.

The second study was based on a total 76,900 hospital years of data with 30-day readmission rates for HF (28,280), AMI (20,936), pneumonia (27,684). The pre-post fixed effect regression coefficients for HEN participation were varied for HF (.018, p=.639), AMI (-.073, p=.032), and pneumonia (.097, p=.003). When using full panel data, the fixed effect regression coefficients were similar to the original sample with 30-day readmission rates for HF(-.032, p=.439), AMI (-.148, p=.001), and pneumonia (.103, p=.014). The sensitivity analysis determined that HEN participants achieved superior AMI readmission improvements over nonparticipants before the HEN program commenced.

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