Emerald | Clinical Governance: An International Journal

Mandatory reporting of healthcare associated infections: Can US experience inform Canadian policy?

Sam Sheps, David Birnbaum — 2012-04-20 00:00:00.0

Abstract

Purpose – This editorial aims to summarize major points from and explains the rationale of a symposium convened in Canada to explore whether American experience with mandatory public reporting of healthcare associated infection (HAI) information can usefully inform Canadian policy. Design/methodology/approach – The symposium brought together members of the Universities Council, an interdisciplinary consortium of Canadian and American researchers organized by the Healthcare Associated Infections Program of the Washington State Health Department. Its members are interested in patient safety generally, and a comprehensive strategy to evaluate HAI public reporting specifically. Findings – American health department experts shared insights from their experience with mandatory reporting; Canadian experts, primarily from the British Columbia Centre for Disease Control, described the current reporting policies of Canadian public health authorities. Presentations were discussed by an audience that included members of the public, allied health professionals, academic researchers, patient safety advocates, the British Columbia Ministry of Health as well as the Canadian Institute for Health Information. The American papers presented are published in this theme issue. Participants found the symposium to be a useful discussion of important issues that identified knowledge gaps underlying the role and value of public reporting in HAI prevention. Discussion of key research agenda issues was informed by the presentations and ensuing discussions. Practical implications – The Universities Council research agenda was confirmed and further informed through the presentations and discussions, affording its members and others a better understanding of current needs and opportunities. Historical and state of the art descriptions of public reporting afforded comparisons of cultures, approaches and early results that can inform any policy makers contemplating relative merits of such programs. Originality/value – Despite much start-up activity in response to demands for more transparency, indications of consumer interest, and some early claims of success, there remain fundamental knowledge gaps and coordination problems hampering achievement of best approaches and value in public reporting. The group brought together in this symposium offers one of the most comprehensive perspectives available on current theory and practice.

Public health implications of healthcare-associated infections: Problems and prospects

Anthony Tellez-Marfin — 2012-04-20 00:00:00.0

Abstract

Purpose – From the symposium keynote address, this paper aims to explore how healthcare-associated infections (HAIs) have been transformed from being only a hospital concern to a much broader public health concern. Design/ methodology/ approach – The paper is a narrative review. Findings – HAIs have the characteristics that define issues as public health problems. As a result, public health departments can become important partners in the evolving hospital infection control field. However, whether all state health departments can afford to add HAI experts and whether current public health department HAI activities will be effective in preventing HAIs remain important questions. Practical implications – Public health agencies must be selective about focusing limited resources into areas where they can protect and improve the public's health; whether HAIs are such an area remains to be seen. Although HAIs have historically been the focus of hospitals and hospital-based services, public health involvement has been mandated through state and federal legislation. In theory, the new mandate is appropriate; in practice, its impact and value need to be comprehensively assessed. Originality/value – The interdisciplinary team required to evaluate HAI mandatory public reporting comprehensively needs to start from an understanding of the history and concepts underlying public health practice.

Mandatory public reporting: The New York State experience

Rachel Stricof — 2012-04-20 00:00:00.0

Abstract

Purpose – This paper aims to describe experience to date with mandatory public reporting of healthcare-associated infection rates from a perspective inside one of the first and most advanced of the state programs, to help frame the research agenda of an interdisciplinary university faculty collaborative. Design/ methodology/ approach – The paper is a narrative review of personal experience. Findings – Key factors enabling program achievements include starting with a sufficient pilot phase, including strong provisions for audit and validation, a balance of viewpoints among advisors to the program, adoption of internationally respected data systems, and ability to sponsor improvement projects in reporting hospitals. Identified pitfalls and needs for more progress also must be addressed. Practical implications – Public health departments are in uncharted territory with this new area of activity, faced with fundamental knowledge gaps that potentially hamper chances of success. Perspectives explored in this part of the Universities Council Symposium help frame a research agenda and guide evolution of less advanced programs. Originality/value – This review helps frame the research agenda of an interdisciplinary university faculty collaborative and guides evolution of less advanced programs.

The US experience with mandatory public reporting

David Birnbaum — 2012-04-20 00:00:00.0

Abstract

Purpose – From a perspective inside one of the most advanced of the state programs, this presentation aims to explore issues of whom are we trying to reach; what information are we trying to convey; when did this reporting start; where can anyone find reports; why are we doing this; and how does it work. This is, however, neither a typical consumer informatics problem nor a subject that public health is used to dealing with. Design/ methodology/ approach – The paper is a narrative review of personal experience. Findings – Despite achievements, there are fundamental knowledge gaps and unsubstantiated assumptions underlying mandatory public reporting. Research and better role delineation are urgently needed to optimize current choices and ultimately determine whether this is the most cost-effective strategy among alternative prevention investments. Practical implications – Public health departments are in uncharted territory with this new area of activity, faced with fundamental knowledge gaps that potentially hamper chances of success. Perspectives explored in this part of the Universities Council Symposium help frame a research agenda and guide evolution of less advanced programs. Originality/value – The Universities Council, established and coordinated by Washington State's HAI Program, is unique in taking an interdisciplinary approach to comprehensive examination of the unsubstantiated assumptions underlying mandatory public reporting.

Public reporting of HAI rates: What we (mostly don't) know

Bernard Black — 2012-04-20 00:00:00.0

Abstract

Purpose – Health-care associated infections (HAIs) kill about 100,000 people annually; many are preventable. In response, 18 states currently require hospitals to publicly report their infection rates and national reporting is planned. Yet there is limited evidence on the effects of public reporting on HAI rates, and none on what elements of a reporting plan affect its impact on HAI rates. The author aims to review here what little we know, emphasizing his own case study of Pennsylvania. Design/methodology/approach – The paper contains a narrative description of empirical challenges in attributing changes in infection rates to the introduction of public reporting, and the author's own research findings from a case study of Pennsylvania using both infection rates estimated from administrative (billing) data (“inpatient rates”) and public reported rates. Findings – Hospitals, faced with public HAI reporting, may respond both by reducing infection rates and through time-inconsistent reporting (“gaming”). Both effects are likely to be stronger at hospitals with high reported rates, relative to peers. From 2003-2008, Pennsylvania inpatient CLABSI rates dropped by 14 per cent, versus a 9 per cent increase in control states. The overall drop comes primarily from hospitals in the highest third of reported rates. Reported CLABSI rates fell much faster, by 40 per cent, from 2005 to 2007. This difference suggests time-inconsistent reporting. Practical implications – Much more research is needed before we can have confidence that public reporting affects HAI rates (and for which HAIs), or know how to design an effective reporting scheme. HAI reporting cannot yet be considered to be “evidence based.” National reporting mandates will foreclose the state experiments needed to address these questions. Originality/value – What little we know about impact of public reporting on HAI rates comes in significant part from the case study of Pennsylvania described in this article.

Factors influencing healthcare consumers' search for healthcare associated infection information on the World Wide Web

Paulette S. Reid, Elizabeth M. Borycki — 2012-04-20 00:00:00.0

Abstract

Purpose – This paper seeks to provide a narrative review of some of the factors that influence healthcare consumers' information seeking involving healthcare associated infections (HAI) on the internet. Design/methodology/approach – The paper takes the form of a narrative review arising from the authors' presentation and subsequent discussions that took place during the Universities Council Symposium held in Vancouver, Canada in May 2011. Findings – There are a number of important factors that affect healthcare consumers' desire to seek information online about HAI, including the search engine used, the type of technology used, web site usability, information availability, consumers' learning style, consumers' personality traits, and finally, consumers' situational, emotional, and psychological contexts. These factors may affect healthcare consumers' decision making about where they will obtain healthcare (i.e. in their selection of a clinic, hospital, regional health authority and/or health care system). Research limitations/implications – HAI reporting via web sites is being done by health care organizations across North America. There is a need to more fully understand the factors that affect consumer use of these web sites. Practical implications – Fundamental questions have been raised about the impact of providing HAI information over the WWW. There is a need to consider the varying factors that influence consumers' information seeking involving the WWW (i.e. technology-driven and consumer-driven factors) especially when searching for HAI-related information about health care organizations. Originality/value – Historically, HAI information was the purview of those who had a background to interpret such data (e.g. infection control and public health practitioners). The literature focusing on what consumers want to know regarding HAIs over the WWW is only beginning to emerge. More research is needed to better understand what health care consumers need to support their decision making involving HAIs.

State and federal legislative interests

David Birnbaum, Rachel Stricof — 2012-04-20 00:00:00.0

Abstract

Purpose – This paper aims to briefly describe the increasingly complex array of organizations influencing American healthcare-associated infection (HAI) prevention efforts during the modern era of infection control. Design/methodology/approach – This paper is a narrative review. Findings – The modern era of hospital infection control began in the 1950s, but received relatively little publicity until the dawn of the twenty-first century. Since then, there has been a wave of unprecedented magnitude in individual state legislation mandates followed by a shift from state to federal agency activity. The resulting programs are in varying stages of development, ability, sustainability, and coordination. Practical implications – Many government and healthcare entities are in uncharted territory with this new area of activity, facing challenges in having to coordinate work with many new and unfamiliar partners. Perspectives explored in this part of the Universities Council Symposium help by mapping out the various stakeholders in order to foster a research agenda through better understanding of powerful political players and their influence. Originality/value – This is one of the first efforts to describe and map the evolving range of state and federal forces influencing hospitals' efforts to prevent healthcare-associated infections.

What can Canada learn from the USA's experience in reducing healthcare-associated infections?

William R. Jarvis — 2012-04-20 00:00:00.0

Abstract

Purpose – The purpose of this paper is to briefly review the history of healthcare-associated infection (HAI) prevention programs in the USA since the early 1970s until today, and provide suggestions how other countries (and Canada specifically) may learn from this experience to accelerate HAI prevention and patient safety improvements in their counties. Design/methodology/approach – The paper is a narrative review of literature and personal experience. Findings – US hospitals have had healthcare-associated infection (HAI) prevention programs, including surveillance for selected HAIs, since the late 1960s-early 1970s. Such programs began with active surveillance for HAIs based upon the Centers for Disease Control and Prevention's (CDCs) National Nosocomial Infections Surveillance (NNIS) system. This system included standardized definitions and surveillance protocols. Since the 1980s, the CDC has developed HAI prevention guidelines, with categorized recommendations for HAI prevention. In the early 2000s, the Institute of Medicine published a report outlining the harm caused by HAIs. This led to increased attention to HAI prevention by an increasingly wide variety of organizations. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) initiated HAI prevention efforts. Many studies documented the failure of hospitals to fully implement evidence-based practices. The increased attention to HAIs and their morbidity and mortality led to media reports and ultimately an initiative by the Consumer's Union for mandatory reporting of HAI rates by hospitals in all states. Subsequently, the CMS introduced decreased reimbursement for the additional costs directly related to HAIs (and other critical incidents) and linkage of reimbursement levels to hospital HAI rates. Together, mandatory reporting and reduced reimbursement for HAIs has led hospital executives to focus more attention on infection control programs to decrease HAI rates. Progress on preventing HAIs seems to be related to standardizing evidence-based HAI prevention bundles, mandatory reporting, and paying for performance (or not paying for preventable HAI complications). Given that voluntary HAI prevention programs have existed since the 1970s, it appears that regulation, reporting, and decreased reimbursement has resulted in more rapid implementation of HAI prevention programs and improved patient safety. Practical implications – The different major activities enhancing HAI prevention in the USA are outlined in an historic context. Originality/value – Understanding the history of progress in hospital infection control efforts provides an essential perspective for policy makers and for the interdisciplinary team required to evaluate HAI mandatory public reporting in a comprehensive manner.

Effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups

2012-04-20 00:00:00.0

Behavioural strategies in diabetes prevention programs

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Comparisons between different polychemotherapy regimens for early breast cancer

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Prostate Specific Antigen Based Screening for Prostate Cancer

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Antihypertensive drugs and risk of cancer

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Enhanced recovery pathways optimize health outcomes and resource utilization

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Effect of metformin on cardiovascular events and mortality

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Statins for primary prevention in people at low cardiovascular risk

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Self monitoring of oral anticoagulation

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Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death

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Health technology assessment

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EVerT: cryotherapy versus salicylic acid for the treatment of verrucae – a randomised controlled trial

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The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews, registry database analyses and economic evaluation

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A systematic review and economic evaluation of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease

2012-04-20 00:00:00.0