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

http://www.enchantedlearning.com/usa/states/texas/