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Health Care Industry

Mandatory reporting and pay for performance: health care infections in the limelight

AORN Journal, April, 2008 by Kathleen Meehan Arias

In the past five years, many articles have been published about health care's "dirty little secret" variously known as a nosocomial, hospital-acquired, or health care-associated infections (HAIs). These articles have appeared in popular newspapers and magazines such as the Wall Street Journal, Washington Post, New York Times, Forbes, Time, US News and World Report, Ladies Home Journal, and Ms Magazine, and they have been widely distributed to local newspapers through the Associated Press. In addition to publicity in the print media, in 2006 and 2007, HAIs were discussed on radio and television talk shows such as

* Morning Edition,

* National Public Radio,

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* Lou Dobbs Tonight,

* 20/20,

* ABC Nightline,

* NBC Dateline, and

* Good Morning America.

It is clear that HAIs have moved into the national limelight.

In 2000, the Institute of Medicine (IOM) published a report titled To Err is Human: Building a Safer Health System (1) that revealed the extent of medical errors and adverse outcomes in US hospitals. The authors outlined a comprehensive strategy for health care providers, industry partners, government officials, and consumers to reduce preventable medical errors, noting that the knowledge already exists to prevent many of these mistakes. Additionally, they noted that despite the presence of hospital infection surveillance, prevention, and control programs, HAIs affect approximately two million patients in acute care facilities each year. They also called for the establishment of a nationwide, public, mandatory reporting system to provide for the collection of standardized information by state governments about adverse events that result in death or serious harm. (1)

Since 2002, several consumer organizations have established successful campaigns to call attention to the problem of HAIs. These include the Consumers Union's Stop Hospital Infections campaign (2) and the RID campaign sponsored by the Committee to Reduce Infection Deaths. (3) Both of these organizations' web sites contain links to media reports on HAIs and provide patients with a mechanism to share their hospital experiences or their stories about HAIs.

ARE HOSPITAL INFECTIONS REALLY A PROBLEM?

There is no doubt that HAIs are a major problem worldwide. They are a common adverse event affecting patients, their family members, and health care systems in both developed and resource-poor countries. At any time, more than 1.4 million people worldwide suffer from complications of infections acquired in a hospital. (4) It is estimated that $4.5 to $5.7 billion was added to the cost of patent care in the United States in 2001 as a result of HAIs. (5) The Centers for Disease Control and Prevention (CDC) estimated in 2002 that there were

* 4.5 HAIs for every 100 admissions to US hospitals,

* a total of 1.7 million HAIs, and

* 99,000 HAI-associated deaths. (6)

These data indicate a rate of one HAI-associated death every 5.3 minutes.

WHY FOCUS ON MANDATORY REPORTING?

As a result of the IOM's report, media attention on HAIs, efforts to reduce health care costs, and consumer dissatisfaction with the quality of health care, (7) there is an increased demand for mandatory reporting of hospital infection rates. For the past five years, the Consumers Union has actively promoted the public disclosure of infection rates, stating that "If hospitals disclose this key information, consumers and employers can select the safest hospitals, and hospitals will be motivated to improve." (2)

WHAT REPORTING REQUIREMENTS CURRENTLY EXIST?

Reporting requirements are being addressed at both the state and national levels. State mandates for reporting HAI rates and other infection-related measures are changing rapidly. From 2002 through 2006, 16 states enacted legislation requiring the reporting of data on HAIs. As of September 2007, an additional 17 states had proposed or enacted HAI-reporting legislation. As of mid September 2007,

* 21 states have requirements for infection-related reporting, which includes

** 19 states (ie, Colorado, Connecticut, Delaware, Florida, Illinois, Maryland, Maine, Minnesota, Missouri, New Hampshire, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, Washington) that make rates public and

** two states (ie, Nebraska, Nevada) that report rates only to a state agency;

* two states (ie, California, Rhode Island) have laws requiring reporting of other infection-related information but not infection rates;

* one state (ie, Arkansas) passed legislation that establishes a voluntary system for reporting infection information; and

* seven states (ie, Alaska, Georgia, Indiana, Kansas, Louisiana, New Mexico, Utah) have passed bills to study the development of infection-reporting requirements.

The infection data to be reported varies from state to state, and some states already have added or deleted infection-reporting requirements.

The most common infection rate to be reported is central line-associated bloodstream infection? Several states are requiring data on selected surgical site infection (SSI) rates (eg, rates for hip or knee arthroplasty, abdominal and vaginal hysterectomy, coronary artery bypass graft). Some states have selected the reporting of specific quality measures, such as appropriate receipt of antibiotic prophylaxis for surgery as recommended by the Surgical Care Improvement Project? Most states require only hospitals to report this data; however, some states have included nursing homes and ambulatory (ie, outpatient) surgery centers in their reporting requirements.

Health Care Industry

Mandatory reporting and pay for performance: health care infections in the limelight

AORN Journal, April, 2008 by Kathleen Meehan Arias

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