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Accuracy of quality measurement for the Hospital Acquired Conditions Reduction Program
  1. Kyle H Sheetz1,
  2. Andrew Ryan2
  1. 1 Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Andrew Ryan, School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI 48109, USA; amryan{at}

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To the Editor

The Centres for Medicare and Medicaid Services (CMS) announced the Hospital Acquired Conditions Reduction Program (HACRP) in 2013, which penalises the 25% of hospitals in USA with the highest rates of hospital-acquired conditions (HACs). CMS uses two domains to measure the incidence of conditions for this programme—the Agency for Healthcare Research and Quality’s Patient Safety Indicators (PSI-90) (Domain 1) and the National Healthcare Safety Network (NHSN) hospital-associated infection measures (Domain 2). Domain 2 constitutes 85% of the total score used to levy financial penalties against hospitals. The PSI-90 composite is derived from Medicare claims; the NHSN measures are derived from an electronic registry managed by the Centres for Disease Control and Prevention. While many agree that reducing harm from hospitalisations is an important national priority, there are concerns that the PSI-90 composite is not valid,1 2 the NHSN measures may undercount events among hospitals looking to avoid financial penalties,3 and neither have robust auditing mechanisms to ensure data accuracy.4


We used data from the Michigan Surgical Quality Collaborative (MSQC),5 a prospective clinical registry, to replicate the HACRP measures according to publicly available specifications from CMS.6 Data for this registry are collected by trained nurse abstractors and audited regularly to ensure accuracy. We constructed our MSQC clinical registry cohort using the same HACRP measurement periods for Domain 1 (July 1, 2014 to September 30, 2015) and Domain 2 (January 1, 2015 to December 31, 2016). These are the measures and time periods referenced by …

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  • Contributors KHS and AMR both contributed to the study concept and design, as well as the analysis and interpretation of the data. Both authors drafted and critically revised the manuscript.

  • Funding This study was funded by Agency for Healthcare Research and Quality (grant number: 1R01HS026244-01; 2T32HS000053-27) and National Institute on Aging (grant number: R01AG047932).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.