Transcript Mandatory Public Reporting of Hospital Infections

Mandatory Public
Reporting of Hospital
Infections
Karla Voy, MPH, MS, CIC
March 8, 2005
Consensus Conference
Hospital Infections
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Incidence 1995
1.8 million
4.7 / 100 admissions
9.7 / 1000 pt days
96,000 deaths
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Incidence 2004
1.7 million
4.5 / 100 admissions
9.3 / 1000 pt days
99,000 deaths
4.6 million with home
and long term care
Consensus Conference
Issue with NNIS benchmarks as a gold
standard
 Not good enough anymore to be better
than the average
 1975 – 2002, IC rate per 1000 pt days up
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 Inpatient
days and ALOS down
 Given changes in the population believe we
are doing better
Consensus Conference
Trend is down for BSIs
 Trend is down for SSIs
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 SIPP
compliance rates
 56% within 1 hour
 41% stopped at 24 hours
 92% appropriate antibiotic selected
Consensus Conference
Antibiotic resistance trends up
 Clinician as stakeholder
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 95%
perceive it as a national problem
 77% as a problem in their institute
 65% in their own practice
 Need to put a face in a rate
Consensus Conference
Prevention is primary
 Need to bridge evidence-based practice
gaps with the reporting of infection rates to
determine rate of preventability
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Denise Cardo, MD, Director, Division of Healthcare Quality
Promotion and CDC
Consensus Conference
The Consumer
It is a problem – 5-10% of hospitalized
patients develop an infection
 Costs a lot of money
 90,000 die
 Real stories
 Secrecy around the situation
 Want to give the system a shove
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Consensus Conference
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No brainer – evidence-based practices
Improve care through awareness and
comparative information
HAI is semantics – people do not understand
what this is
Public pressure does work
Lisa McGiffert, Senior Policy Analyst on Health Issues and the Project
Director for StopHospitalInfections.org a project of Consumers
Union, publisher of Consumer Reports
Consensus Conference
Healthcare Industry
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Accountability
Promote
 Informed public
 Market forces deal
with poor
performers
 Promotes broader
action
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Learning
Promote
 Clinical judgment
leads to better care
 More useful,
credible information
 Data reflect care
Consensus Conference
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Accountability
Guard against
 Data gamed
 Data not actionable
 Improvement
agenda hijacked
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Learning
Guard against
 Actions too slow,
small, and diffuse
 Bad actors still
practice
 Patients kept in the
dark
Consensus Conference
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What is needed?
 Valid measures
 Case finding and data collection specifications
 Trusted data collection pathway
 Method for verifying data collection
 Data analysis methods
 Data display options
Nancy Foster, VP for Quality and Patient Safety Policy at the American
Hospital Association
Consensus Conference
Surveillance
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National Healthcare Safety Network
 NNIS
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(1970-2004)
Nosocomial infections in critical care/surgery pts
 NaSH
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Exposure to BBP, TB, Vaccine adverse events
 DSN
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(1999-2004)
(1996-present)
BSI and vascular access infections dialysis outpts
Consensus Conference
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NHSN Components
 Patient
Safety
 Healthcare Personnel Safety
 Research and Development
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How data are shared in NHSN
 A group
can enroll in NHSN (i.e., Healthcare
organizations, State HDs, Quality Improvement
Organizations)
 A facility can then join the group and share data
Consensus Conference
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Timeline for rollout
 1 – Training and enrollment started in Nov 04;
reporting started Jan 05 (NNIS, DSN, NaSH
members, special collaborators)
 2 – These members’ “sister” institutions (Mar 05)
 3 – Any healthcare entity (Jul 05)
 Internet security still being tested
Teresa Horan, MPH, Chief, Performance Measurement Sections at
Division of Healthcare Quality Promotion
Consensus Conference
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International Perspective
 Whatever N. America decides will have a
global impact
Carthryn Murphy, PhD, Associate Professor,
Wollongong University
Consensus Conference
Liability Issues?
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National survey on consumer’s experiences with patient
safety and quality information
 34% personal medical error
 21% serious
 16% severe pain
 16% loss of activities
 23% temporary or long term disability
 8% death
 11% initiated malpractice suit
Consensus Conference
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Issues with current data
 Outdated
 No
opportunity to show improvement trends
 CONFUSING
Different time frames
 Different data sources
 Different displays
 Different scales
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Consensus Conference
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Potential use by plaintiff’s counsel in an attempt
to discredit hospital
Is voluntary reporting of aggregate data enough
to constitute waiver from discovery
Confidentiality protections
Tammy Lundstrom, MD, VP, Chief Quality and Safety Officer at the
Detroit Medical Center
Consensus Conference
JCAHO – Are we there yet?
Measurement is not a neutral activity –
creates stress
 Need multiple measures to paint an overall
picture
 Need risk adjustment
 No agreement on whose reporting is better
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Consensus Conference
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Hospitals with poor surveillance and data
collection will look better
No evidence that mandatory reporting is better
than voluntary
No one wants to pay for mandatory reporting
and it costs
Need built in incentives for voluntary reporting
Consensus Conference
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Do not think that legislation in 50 states will fix
the problem
Need standardization
Need information technology separate from
measuring
Pay for performance – are we robbing peter to
pay for paul – leaves hospital without resources
when access is already an issue
Jerod Loeb, PhD, Executive VP for Research at the JCAHO in Illinois
Consensus Conference
21st Century Media
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Bogey man with a note pad?
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Take press by the hand (wash afterwards)
Counter the problem, offer a solution
 What? So What? Now What?
 All health care institutions are equal; some more equal than
others – public does not differentiate differences
 It’s 90 days later; anyone seen the press? (once people
understand the differences the issue will become less important)
Jim Battaglio, President, Creative Writing Co., Corporate Communications, VP
President Emeritus for Hartford Hospital
Consensus Conference
Illinois Perspective
 SB 59 - Hospital Report Card Act –
effective Jan 2004
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 Daily
nursing staffing assignments by unit
available to public
 Quarterly nursing hours per patient, average
daily census/hours worked for each clinical
service area
Consensus Conference
 Mortality
 Infections
(CDC definitions)
Class I SSI (SIP, then SCIP, hopefully SCIPI)
 VAP
 CLA-BI
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 Advisory
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Group
Begin or end each meeting with a consumer who
has a story of infection
Consensus Conference
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Develop national standardized measures
Shift to electronic health record now
DOH is developing rules for reporting
Patricia Merryweather, Senior VP, Illinois Hospital
Association
Consensus Conference
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Florida Initiative
HB 1629 – Relating to Affordable Healthcare passed spring 2004
 Complication
rates
 Re-admission rates
 Infection rates
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Not further defined, unfunded
Working group
Consensus Conference
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SIP measures
 Available/valid/endorsed
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Comprehensive Health Information
System Advisory Council
 Technical
workgroup for health care facility
web site
 Technical workgroup for hospital acquired
infections
Consensus Conference
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Education of team members is key
Rules published Dec 31, 2004
Report using CMS criteria and timing
Meeting every 2 weeks
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20-40 people
Rate was initially in rule language, but convinced to
move to process measure
Loretta Fauerbach, MS, CIC, Director of IC for Shands
Hospital at the UF and Shands HealthCare system
Consensus Conference
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Missouri SB 1279 - Nosocomial Infection Act of
2004
Advisory Panel
Consistent with CDC guidelines/standards
 MRSA and
 Class
I SSI
 CLA-BI
 VAP
VRE
Consensus Conference
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Reporting rules
Exemptions for hospitals (NNIS approach)
Dec 31, 2005
 Ambulatory
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June 30, 2005
 CLA-BIs
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surgery clinics (breast, hernia)
in the ICU
June 30, 2006
 SSIs
(hip prosthesis, c-section, CABG)
Consensus Conference
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MRSA/VRE – quarterly antibiogram
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Whatever hospital is monitoring
Surveillance/colonization cultures excluded
Problems with consumer model legislation
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Timing – takes time to do right
Advisory group, outside healthcare – we are the experts
Risk adjustment – no consistent standard
Eddie Hedrick, BS, MT (ASCP), CIC, Emerging Infections
Coordinator for the Missouri DOH and Senior Services
Consensus Conference
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Pennsylvania
Mandated by an independent state agency
(PHC4) rather than legislative initiative
Had no opportunity for input – announced Nov
03 with reporting to start in Jan 04
Challenged and HAI Advisory Panel met Feb
2004 (already collecting data 6 weeks)
Initially PHC4 felt ICP not needed to collect data
Consensus Conference
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Urinary catheter UTI
VAP
Catheter-associated BSI
SSI (ortho/musculoskeletal, neurosurgery,
circulatory system)
Children’s Hospitals
Inpatient Rehab Facility
Long Term Acute Care Hospitals
Consensus Conference
First data was submitted no later than
6/30/04
 Discrepancy in numbers of infections that
hospitals reported to PHC4 for billing
purposes and numbers of HAIs reported to
PHC4
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 Reported
press
to industry/media resulting in bad
Consensus Conference
PHC4 goal is hospital-wide collection of all
HAIs by Jan 1, 2006
 To date, PHC4 has not determined how
HAI data will be analyzed/published
 Challenge – prevent the preventable
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Consensus Conference
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Lessons Learned
 Focused surveillance ICU loses big picture
 Disparity in field on interpretation
 UTIs significant cost outside ICU arena
 Administration starting to see business case
for
preventing infections
 Can’t keep adding tasks to ICPs without losing value
to the process
Sharon Krystofiak, MS, MS, MT(ASCP), CIC, Manager
of IC at Mercy Hospital in Pittsburgh, PA
Where we stand Feb 5, 2005
4 states require mandatory reporting
 32 states with pending legislation
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Guidance on Public Reporting of
Healthcare-Associated Infections
(HICPAC) Feb 28, 2005
Insufficient evidence on merits/limitations
of an HAI public reporting system
 Process measures
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 Target
adherence rate (100%) unambiguous
 Do not require risk adjustment
 Should measure common practice
Guidelines
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Process measures
 Adherence
rates central-line insertion
practices
 Surgical antimicrobial prophylaxis
 Influenza vaccination healthcare
personnel/patients/residents
Guidelines
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Outcome measures
 Frequency,
severity, preventability, likelihood
they can be detected and reported accurate
 Substantial morbidity/mortality/cost
CLA-LCBIs
 SSIs
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Guidelines
Standardized methods for case-finding
 Method to validate
 Reporting system can’t produce quality
data without adequate resources
 Risk adjustment
 Reports convey useful/interpretable
information to diverse audience
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Guidelines
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Potential consequences
 May
reduce HAI rates
 May divert resources to reporting infections
and collecting data for risk adjustment and
away from patient care and prevention
Guideline Recommendations
Use established public health surveillance
methods when designing and
implementing mandatory HAI reporting
systems
 Create a multidisciplinary advisory panel
to monitor the planning and oversight of
the operations and products of HAI public
reporting systems
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Recommendations
Choose appropriate process and outcome
measures based on facility type and phase
in measures gradually to allow time for
facilities to adapt and to permit ongoing
evaluation of data validity
 Provide regular and confidential feedback
of performance data to healthcare
providers
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Ohio HB 541
Met with Rep Raussen
 Letter delivered with one voice from all
Ohio APIC Chapters
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 Establish Advisory
Group
 Chartered with specific responsibilities
 Phased approach/Florida as example
HB 541
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Proposed Performance outcome data
 Number of cases
 Average billed charge
 Average LOS
 Readmission rate
 Complication
 Mortality rate
 Infection rate
rate
- % of pts develop an infection while
admitted to hospital
 Whether electronic system used to order drugs
HB 541
Maintaining communication with his office
 Awaiting final version of bill (number will
change)
 Spokespersons selected to
represent/maintain communication/answer
questions for Rep Raussen’s office
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Key Stakeholders/Special Interest Groups
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Consumers Union
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Committee to REDUCE INFECTION RATES (RID)
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http://www.hospitalinfectionrates.org/
The Leapfrog Group
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http://www.sonsumersunion.org/campaigns/stophospitalinfection
s/learn.html
http://www.leapfrogfroup.org
Services Employee International Union (SEIU)
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http://www.seiu.org/health/nurses/safe_staffing/fed_leg_studies.c
fm
Questions