Impact of Quality Improvement Support on Hospital Readmissions and Patient Safety Outcomes: A Quasi-Experimental Study of a National Quality Improvement Initiative

Background: The Centers for Medicare & Medicaid Services (CMS) administers the Hospital Quality Improvement Contractor (HQIC) program to improve healthcare quality and safety in hospitals serving Medicare beneficiaries. These contractors provided technical assistance to small, rural hospitals, and/or to hospitals with lower quality ratings. This study aimed to evaluate the program effectiveness in addressing two priority areas: reducing hospital readmissions and increasing patient safety. Methods: A quasi-experimental design was used to assess the impact of HQIC support on 30-day all-cause readmissions and eight patient safety outcomes in hospitals that received support between October 1, 2020, and December 31, 2023 (N = 1,929). Patient safety outcomes included adverse drug events (ADEs) and healthcare-associated infections (HAI). A difference-in-difference model specification with a Poisson generalized estimating equation was used to compare hospitals receiving support for each outcome to matched hospitals that did not receive HQIC support. Results: Receiving HQIC support was associated with a 1.4% reduction in the number of 30-day all-cause readmissions compared to hospitals with similar characteristics that did not receive HQIC support for readmissions. Hospitals receiving HQIC support for reducing catheter-associated urinary tract infections (CAUTI) showed a 17.4% reduction in the number of CAUTI events relative to hospitals that did not receive support. There was no statistically significant effect on the other outcomes. Conclusions: The HQIC program support had an impact on reductions in hospital readmissions and reductions for one of the HAIs but not on other patient safety outcomes. These findings suggest a targeted approach in resource allocation may improve readmissions and CAUTI rates for small and rural hospitals.