texas: public reporting of healthcare- associated infections ? susan jones ba, mph, m(ascp), cic,...
TRANSCRIPT
Texas: Public Reporting of Healthcare-
Associated Infections ?
Susan Jones BA, MPH, M(ASCP), CIC, CHSPInfection Control Practitioner
OBJECTIVES
Discuss history of public reporting in Texas Describe current legislation on public
reporting in Texas
Not “New” to Texas
75th Legislative Session
HB 418: Reporting of quarterly and annual “hospital infection rates”– Filed 01/09/97 by Maxey– Read First Time 02/03/97– Referred to Public Health 02/03/97 …
HB 418: Why Not Passed?
“Hospital Infection Rate”– Numerator?– Denominator?– Definitions of Infection?– Targeted Surveillance?– Risk-Adjustment?
A Different Time & Place
Since Then …A Storm Has Been A Brewing
A Different Culture from 1997– 1999 -- IOM “To Err is Human” Report– Consumer Groups
Leapfrog Consumers Union (Stop Hospital Infections) RID (Reduce Infection Deaths)
– IHI Bundles Institute for Healthcare Improvement 100K Lives Campaign
79th Legislative Session: 2005
SB 609
Filed by Nelson 02/21/05 Referred to Senate HHS 03/01/05 First Public Hearing 03/08/05 Got Out of Committee … Amendments Amendments Tabled Eventually added as an ‘amendment’ to the
‘niche hospital study bill’ SB 872
SB 872: What is the “Charge”
Establishes a 14 Person Advisory Panel Submit 11/01/06 Report to the
Commissioner and to the Presiding Officer of Each House– Advisory Panel’s Recommendations
Infection Rates Process Measures Or, Both
HAI Advisory Panel MembersTSICP is Involved – Patti Grant, Greg Bond, Susan Jones, Linda Watkins
4 ICP’s, CIC, hospitals (1 rural)
1 CEO of Hospital 1 CEO of ASC 3 Texas DSHS 2 Consumers 3 MD’s, Membership in
SHEA
Texas HAI Advisory Panel
Will file a report with– Formal Recommendations in Texas Format– Fiscal Note Inclusion– A lengthy evidence-based “White Paper”– Appendix
Definition of ICP Definitions of Infection Infection Prevention Program ‘Scorecard’
HAI Advisory Panel Progress
Voluntary Study of IC Programs in Texas sent to CEO’s: 437 hospitals & 274 ASCs
– 37% (179/435) Response Rate for Hospitals– 13% (35/274) Response Rate for ASC’s– Large variety of customized programs– Provided Some ‘Insight’ into Current Texas
Resources for IC&P Programs
Tentative Texas HAI Report …
Texas: Key Recommendations
Data to help consumers make informed decisions for care related to HAI’s– Meaningful Data Comparisons
Incentivize facilities to HAI’s by doing high yield outcome measurement– Specific ‘apples to apples’ comparisons
Reduce HAI costs and LOS
Texas: Key Findings
Focus on Evidence-Based Outcome Measurement (Not Process)
Rely on trained ICP’s to identify and report HAI data
Texas DSHS provide ICP training on software reporting (qualified)
Texas: Key Findings
Hospital Discharge Diagnosis Codes not Used to identify HAI’s for Public Reporting
Focus on HAI type and data collection per evidence-based literature
Must follow CDC NSHN Guidelines and Definitions
What’s Looking “A GO”for HAI Public Reporting
RSV rates in pediatric populations -- Rate– Not “just” in Children’s Hospitals
Surgical Site Infections – Patient Level Data– Mandated Post D/C Surveillance to Surgeons
Central-Line Associated BSI -- Rate– Laboratory-Confirmed– Risk-Stratified by ICU Type– NICU stratified by birthweight
Safeguards to Culture Change
Future Direction– More “Patient-Level” Data
Confidentiality of Data– HIPAA
Immunity Protections for Reporting– Litigation
Data Validation– Power of Texas DSHS to Investigate
No Guarantee HAI Advisory Panel recommendations will become “Law”
What About The Entire USA?
2002 Only 2 states with HAI Public Reporting
Activity
As of 2006 the NQF has an entire project to identify a ‘consensus’ on what each state should be doing for public reporting of HAI’s … so can have state to state comparisons
WEBSITES
Texas Legislature Line
http://tlo2.tlc.state.tx.us Leapfrog
http://www.leapfroggroup.org Institute for Healthcare Improvement (IHI)
http://www.ihi.org Reduce Infection Deaths (RID)
http://www.hospitalinfection.org National Quality Forum (NQF)
http://www.qualityforum.org
