Value-based incentive programs were not associated with decreased rates of catheter-associated urinary tract infections (UTIs) in the intensive care units (ICUs) of large hospitals, according to a study published in JAMA.

Researchers analyzed data from the National Healthcare Safety Network database to assess the association between value-based incentive programs and catheter-associated UTIs in ICU settings. Catheter-associated UTI-related quality measures were device-associated infection rates, population-based infection rates, and indwelling urinary catheter device use. The value-based incentive programs monitored were the Hospital Value-Based Purchasing Program and the Hospital-Acquired Condition Reduction Program. Data on the hospitals were compiled from the American Hospital Association annual survey.

There were 1185 ICUs included in the study, including 22,572,494 patient-days and 13,607,240 indwelling urinary catheter days. The value-based incentive program did not appear to significantly change the rate of decline in catheter-associated UTI. The implementation of the value-based incentive program did not affect immediate changes or trend changes for device-associated catheter-associated UTI, population-based catheter-associated UTI rates, or device use rates.

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Limitations of this study include using catheter-associated UTIs as the primary focus and limiting the analysis to single health care-associated infections due to uncertainty in additional outcomes.

The researchers concluded that the negative outcomes of this study “call into question the effectiveness of [value-based incentive programs] for catalyzing improvements in care quality and underscore the importance of ongoing rigorous policy evaluations.”


Hsu HE, Wang R, Jentzsch MS, et al. Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care settingJAMA. 2019; 321(5):509-511.