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Comment & Response
September 2015

Ongoing Attention to Injurious Inpatient Falls and Pressure Ulcers

Grace M. Lee, MD, MPH1,2; Stephen B. Soumerai, ScD1,2; for the Preventing Avoidable Complications by Adjusting Payment (PAICAP) Study Team
Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Harvard Pilgrim Health Care Institute, Boston, Massachusetts
JAMA Intern Med. 2015;175(9):1581-1582. doi:10.1001/jamainternmed.2015.2552

To the Editor We read with interest the article by Waters et al1 because we believe it is vital to evaluate whether the actual effect of payment policies matches their intended effect. The authors contribute unique information about the results of the Centers for Medicare & Medicaid Services Hospital-Acquired Conditions Present on Admission Indicator (HAC POA) on pressure ulcers and injurious falls, using data from the National Database of Nursing Quality Indicators. However, their findings contradict those of our previously published study evaluating the impact of the HAC POA program on rates of central line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs).2 We continue this important conversation for the benefit of patients, clinicians, hospital leadership, and policymakers, and we raise the following key concerns with the goal of increasing transparency and ensuring that conclusions about the effect of the HAC POA program are robust.

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