HB 197

Barbara W. Bradley, MS, RN, CICChief, Bureau of Infectious Disease ControlOhio Department of Health

Enactment of House Bill 197HB 197 became law in November 2006

Requires Ohio hospitals to report performance measure data to the Ohio Department of Health for the purpose of public reporting

Some measures are required to be selected from several national organizations: Centers for Medicare and Medicaid Services (CMS) The Joint Commission on the Accreditation of

Healthcare Organizations (JCAHO) National Quality Forum (NQF) Agency for Healthcare Research and Quality (AHRQ)

Creation of Advisory CouncilBy statute, a Hospital Measures Advisory Council was

created and consists of:Director of Health, Council ChairTwo members of the Ohio House of RepresentativesTwo members of the Ohio SenateSuperintendent of InsuranceExecutive Director of the Commission on Minority

Health Representative from each of the following: Health

Insurers, Small and Large Employers, Organized Labor, Physicians in General Practice, Physicians Specializing in Public Health, Children’s Hospitals, Hospitals, Health Care Consumers and Health Services Researchers

Creation of other GroupsEach member of the Hospital Measures

Advisory Council was required to appoint a data expert (Data Expert Group)

An Infection Control Group was also required to provide information about infection measures

The Advisory Council created Pediatric and Perinatal workgroupsThese group looked at measures specific to

these populations

Process for Measure SelectionThe Data Expert Group met monthly to

review each measure created by the organizations mentioned in the law

The Data Expert Group created a set of criteria that would serve as guidelines for selectionThe specifications for each measure were

examined and it was determined whether or not it met the majority of the criteria

Measure Selection CriteriaImportance

Do the measures reflect unequivocally important aspects of patient care?

PreventabilityCan a poor score be prevented through proper care?Is excess variation in the data accounted for by

factors unrelated to hospital quality?Genuine quality improvement

Can a hospital’s rate be improved without improving quality?

Data integrityCan a hospital accurately collect the data from its

records?Does the measure adequately measure the construct

it attempts to measure?

Measure Selection Criteria (cont.)Usefulness of data to the public

Is the measure of use to consumers?Is the measure comprehensible to consumers?Do hospitals have a sufficient case load to accurately report

quality?Burden

Does calculating the measure place undue burden on hospitals?

Evidence-basedIs there scientific research demonstrating the accuracy and

importance of the measure?Variance

Is there sufficient variability in performance among hospitals to allow for comparison?

National Quality Forum endorsementIs the measure endorsed by the National Quality Forum?

Next StepsAdopt rules reflecting recommended

measuresSix to nine month process

Public comment period Public hearing

Reporting of new measures to begin no earlier than October 2009

Development of the consumer websiteTo be operational by January 2010

Hospital Infection ReportingInfection Control GroupMany members from Director’s Advisory

Committee for Emerging PathogensHospital Infection Control

Professionals/Infection Preventionists included

Infectious Disease Physicians included

Background of Hospital Infection Reporting

APIC was conceived in 1972 in recognition of the need for an organized, systematic approach to the "control" of infections acquired as a result of hospitalization. (apic.org)

Hospital reporting of infections into the CDC National Nosocomial Infection Surveillance System (NNIS) has been going on since the early 1970s.

Background (continued)The NNIS database was used to:

Describe the epidemiology of Healthcare Associated Infections (HAI)

Describe antimicrobial resistance associated with HAIs

Produce aggregated HAI rates suitable for interhospital comparison.

Background (continued)The National Healthcare Safety Network

(NHSN) was launched in 2005 as a new electronic surveillance system

One of the enhanced features of this surveillance system is that while maintaining data security, integrity, and confidentiality, NHSN has the capacity for healthcare facilities to share data in a timely manner:Between a facility and public health agencies Between facilities (e.g., multihospital system)

NHSN - PurposeCollect data from a sample of healthcare

facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and healthcare personnel.

Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of HAIs.

Analyze and report collected data to permit recognition of trends.

NHSN – Purpose (continued)Provide facilities with risk-adjusted data that can

be used for interfacility comparisons and local quality improvement activities.

Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and healthcare personnel safety problems and prompt intervention with appropriate measures.

Conduct collaborative research studies with NHSN member facilities (e.g., describe the epidemiology of emerging HAI and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies).

Process Within Hospitals for ReportingOutbreaks in hospitals in Ohio are reportable

to LHD/ODH based on Class C Reportable Infectious Diseases

24 outbreaks in hospitals have been reported since between 2002 and 2007

Infection Preventionist (IP) identifies infection based on reports from hospital staff, microbiology reports, personal observations

IP conducts investigation with standard case definitions provided by infectious disease control manual/ NNIS/NHSN

Process Within Hospitals for Reporting (cont’d)

Identified infections are addressed with the hospital staff and attending physician

A line listing is prepared and the data is characterized by person, place and time

Outbreaks and infection rates are shared with the Infection Control Committee

JCAHO reviews infection control data when hospitals are accredited

Professional OrganizationsMultiple professional organizations are involved in

mandatory reporting of HAIs across the U.S.Association for Professionals in Infection Control and

Epidemiology (APIC)Society for Healthcare Epidemiology of America

(SHEA)Infectious Disease Society of America/Ohio

(IDSA/IDSO)Veterans Administration (VA)Center for Medicare and Medicaid Services (CMS)National Quality Forum (NQF)Joint Commission on Accreditation of Healthcare

Organizations (JCAHO)AHRQ

What has ODH been doing?Bureau of Infectious Disease Control, Bureau

of Health Surveillance Information and the State Epidemiologist have been collaborating on this issue for about 3 years

Director’s Advisory Committee on Emerging Pathogens convened on this issue

National APIC conferences bringing together IPs from across U.S.

ODH staff traveled to Pennsylvania to visit and learn about Pennsylvania system

More of what ODH has been doingMonitoring legislation in Ohio and across the

U.S.Hearing from and monitoring actions of

consumer groupsMade C. difficile reportable in 2006: mandatory

reporting; case definitions; data analysis; education

Participating with LHDs in investigations of HAIs

Training staff across the state in infection control and epidemiology

Available MeasuresWhat do hospital IPs collect now?

Catheter-Associated Bloodstream Infections (CA-BSI)

Surgical Site Infections (SSI)Ventilator-Associated Pneumonia (VAP)Catheter-Associated Urinary Tract Infections

(CA-UTI)Multiple other infections available for

monitoring from NNIS/NHSN system

What offers the best transition to mandatory reporting for hospitals?Use data that is already being collectedUse a standardized data collection systemProvide reporting to meet the statute’s

requirementProvide reports that are easily understood by

healthcare professionalsProvide reports that are easily understood by

the general public

What are the anticipated needs?Public educationProvider educationElectronic system with easy accessStaff to provide education and technical

assistance

Statutory Reporting GuidelinesApril 1st and October 1st of each yearData that reflects performance over a twelve-

month periodUse the specifications and risk adjustment

methodology recommended by the entity that developed or endorsed the measure

Statutory Reporting GuidelinesThe data collected must include measures from

The Centers for Medicare and Medicaid ServicesThe Joint Commission on the Accreditation of

Healthcare Organizations The National Quality ForumThe Agency for Healthcare Research and Quality

The data collected may include other measures that the Hospital Measures Advisory Council recommends to the Director

CMS Infection MeasuresSurgical Care Improvement Project (SCIP) is a

national quality partnership of organizations (CMS, JCAHO, NQF)

There are 9 SCIP procedural measures intended to improve the safety of surgical care through the reduction of postoperative complications

Five measures are currently required for CMS reimbursement and by the end of 2008 others will be required pending NQF endorsement.

AHRQ Infection MeasuresAgency for Healthcare Research and Quality

(AHRQ) currently has two infection control measuresSelected infections due to medical care

This measure is intended to flag cases of infection due to medical care, primarily those related to intravenous (IV) lines and catheters.

Post-operative sepsis This measure is intended to flag cases of nosocomial

postoperative sepsis.

These measures are not currently nationally collected

NQF Infection MeasuresNQF endorses a variety of measures from

multiple National organizations including: CMS and JCAHOCDCIHI (Institute for Healthcare Improvement)Vermont Oxford Network

NQF’s healthcare-associated infections consider infections in 4 clinical areas and 2 specialty areas

Statutory GuidelinesData reported must be made available to

the publicThe public must be able to compare

hospital’s performance in meeting the measures

Infection Control GroupA group of

Health care consumersNursesExperts in infection prevention and control

Provide information about infection control issues to the council as needed for the council to perform its duties

Proposed Charge

To assess and recommend existing hospital associated infection measures that could be used to provide meaningful information to consumers.

What is happening nationally?