Public reporting of hospital infections for informed patient choice: Where does it stand?

Background: Healthcare acquired infections (HAI) occur in an estimated 2 million patients annually, resulting in 90,000 excess deaths and $4.5 billion in excess cost. Infection rates vary among hospitals, and public reporting is considered an important strategy for informing patient choice, and encouraging quality improvement. Recognizing this, numerous state legislatures have mandated public reporting of HAIs. A detailed analysis of state-level initiatives has been performed, but no study to date has reported on the implementation of these initiatives. This study evaluates the accessibility and quality of publically available data for patient decision making purposes.

Methods: Review of state legislation, plus a search for reporting sites, and review of their content.

Results: As of 2008, 24 states have mandated public reporting of HAIs, but only 7 states are actively reporting. The remaining states have either passed their mandated start dates without issuing reports, have no specified start dates, or have planned start dates in the future. The most commonly reported infections are central-line associated bloodstream infections in the ICU, ventilator associated pneumonia, and surgical site infections. Most legislation, and 6 of 7 reporting states, adopts the CDC's National Hospital Safety Network as their reporting system, and state departments of health are most often tasked with issuing the public reports. Frequency of updates is generally annual or biannual, and no reports identify specific infectious strains. Available reports may be hard to locate by consumers. A minority of reporting sites (3/7) utilize searchable databases, only one of which has a tool to facilitate hospital-to-hospital comparison, the rest (4/7) provide PDF or html reports. One has not yet begun to identify hospitals by name. For patients, hospital comparison may also be complicated by the use of technical terminology and methodology. In most cases context for infection rates is provided via comparison with the national average, which may mask poor performing hospitals by making most institutions appear average. Very little guidance is provided to the public on the practical interpretation of the data presented.

Conclusion: Implementation of state-level reporting of hospital infection, as required by law in 24 states, is lagging. States are overwhelmingly using clinical data, statistically valid methods, and robust reporting systems. For efforts to be useful for patient decision making, more emphasis should be placed on implementation, patient-friendly data presentation, and useful guidance.