Ongoing Attention to Injurious Inpatient Falls and Pressure Ulcers—Reply

In Reply We agree with Lee and Soumerai that transparency is needed when evaluating payment policies to ensure that actual outcomes from a policy change match intended outcomes. The best way to ensure transparency is to conduct multiple evaluations, using different hospitals and databases. Deriving different results from a prior study by Lee et al¹ does not necessarily mean our findings are wrong. Given the narrow confidence intervals around our findings and that we controlled for multiple hospital- and unit-level covariates, we believe the methodological concerns raised did not influence our findings. Rather, the location and teaching status of the 1381 hospitals contributing data to our study were quite different from the 398 hospitals in their study. The increased heterogeneity in our data likely provided more opportunity to identify the effects of the policy change.