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Penalties May Not Be Fair Way to Control Infection Rate

UK policy to control C. difficile infection may mean fines are levied even when progress is made

FRIDAY, Nov. 21 (HealthDay News) -- Financial penalties for failure to meet targets to reduce hospital infection due to Clostridium difficile in the United Kingdom may penalize trusts even when hospitals reduce their infection rates, according to a report published online Nov. 20 in BMJ.

A. Sarah Walker, statistician with John Radcliffe Hospital in Oxford, U.K., and colleagues reviewed the financial penalties set by the U.K. Department of Health policy targeting a 30 percent reduction in C. difficile infections in patients aged 2 years and older across the entire National Health Service health economy from 2007-2008 to 2010-2011.

The researchers found that there was a serious risk of demotivating hospital trusts, with a 50 percent chance of being penalized in any single year even if they met target reductions in risk. Even at a target of 10 percent reduction annually, around half of trusts with 250-1000 baseline cases and a true 10 percent risk reduction would still pay a financial penalty (0.4-0.6 percent total contract revenue) in the following contract year. According to the researchers' calculations, to have less than a 5 percent chance of paying a penalty over three years, trusts would have to reduce risk by 10-15 percent more than the target.

"Financial targets, particularly as implemented in the current NHS contract for acute services, may…have unexpected and unwanted effects on the smooth running of trusts, other than achieving the primary aims of much needed reductions in outcomes such as C. difficile infections," the authors conclude.

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