Public Disclosure of Hospital Infection Rates Vary by State
--Johns Hopkins study finds patients “walking in blind” with little access to quality and outcomes data
Newswise
— Only 21 states require public reporting of hospital data on surgical
site infections and, even when disclosure is mandated, the information
is often not easily accessible to patients who could use it to make
decisions about their medical care, according to new Johns Hopkins
research.
The research findings suggest that a haphazard,
state-by-state system for reporting these critical measures of health
care quality isn’t working and that only national guidelines governing
disclosure can paint a clear picture of how well hospitals are doing at
preventing patient harm, the researchers say.
Reporting accurate
data on measures such as rates of
surgical site infections can be an
inexpensive way to actually reduce them, the authors note in their study
published online in the
Journal for Healthcare Quality.
When
patients have access to this information and use it to take their
business to hospitals with lower infection rates for select operations,
the researchers say, hospitals with higher infection rates will have
financial and reputational incentives to quickly find ways to do better.
“
A
lot of information is not available to the public and, if it were,
hospitals would be motivated to improve,” says study leader Martin
Makary, M.D., M.P.H., an associate professor of surgery at the Johns
Hopkins University School of Medicine. “Right now, a hospital can have
high complication rates, high readmission rates and high infection
rates, but because patients can’t look up this information, they’re
essentially walking in blind.”
One example of the impact of such
transparency occurred in New York State
two decades ago, Makary said.
Rates of mortality from coronary artery bypass surgery varied widely
among hospitals before the state began requiring public reporting of
death rates from the procedure. Four years into mandatory reporting
requirements, average hospital death rates from the operation
fell by 41
percent. Makary says he thinks one reason for the precipitous drop is
that “poorly performing hospitals had an incentive to look better to
consumers making health care decisions.”
Researchers estimate
that surgical site infections occur in up to 25 percent of patients
after major surgical procedures and are estimated to cause more than
8,000 deaths a year. The occurrence of a surgical site infection is
increasingly recognized to be largely preventable and, as a result,
rates are being used as a surrogate measure of broader health care
quality.
The Centers for Medicare and Medicaid Services recently
announced that hospitals must soon report surgical site infection rates
for select procedures. Failing to meet benchmarks will result in
financial penalties. But Makary says that the new requirement covers
only a small number of procedures and wider reporting of complications
will initially be voluntary. Makary says Medicare needs to quickly
expand the program and speed up the transition to uniform public
reporting for all hospitals.
In the new study, Makary and his
colleagues found that, as of September 2010,
29 states had no laws
regarding the monitoring and reporting of surgical site infections. Of
the 21 that did have such laws,
only eight made the data publicly
available in an easy-to-access format.
Even then, he said, the
data shared are limited, covering between two and seven procedures.
Seven of the eight states reported surgical site infection rates
following coronary artery bypass graft procedures, six did so for knee
or hip replacement surgeries, and two reported rates after colon
surgery, which nationally has the highest rates of surgical site
infections. Only one state, Ohio, reported rates after gallbladder
surgery, among the most common surgical procedures in the United States.
The average time lag between collection and publication of data was six
months, with a range of two to 11 months.
Makary also says that
states don’t always specify how data are to be collected, resulting in
lack of uniform reporting that can make comparisons impossible. The lack
of national standards, he says, may also disadvantage hospitals that
are better at collecting information, because their rates may appear
higher than those at hospitals that don’t look as rigorously for
infection cases.
“It is important to use a common method or at a
minimum ensure common parameters, inputs and definitions are used,” he
says. “Without that, it is difficult for consumers, payers or regulators
to compare infections within or across states. Unless we are comparing
apples to apples, public disclosure has the potential to
mislead
patients instead of help them.”
