Impact of state mandatory public reporting on hospital-acquired infection rates

Many states have enacted laws mandating public reporting of hospital-acquired infections (HAIs) before the recent universal requirement by the Centers for Medicare and Medicaid Services (CMS). However, little is known about the value of these state laws. We examined whether hospitals in states with prior public reporting (at least one year prior to CMS’s mandate) have lower infection rates than in states without, and whether such differences depend on market competition.

We analyzed 3286 eligible acute care hospitals reporting HAIs to CMS between April 2012 and March 2013. Hospital-specific infection rates were obtained for:  central-line associated bloodstream infections (CLABSI), two surgical site infections (SSI), catheter-associated urinary tract infections (CAUTI), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium difficile (C.difficile). Hospital-level negative binomial regression models were fit for each infection type, controlling for state laws, the interaction with market competition measured by the Herfindahl-Hirschman Index (HHI) and other hospital characteristics.

In highly competitive markets, hospitals in states with prior public reporting have significantly lower infection rates only for the following HAIs: SSI on hysterectomy (IRR=0.85, 95%CI:0.74-0.98);CAUTI (IRR=0.88, 95%CI:0.78-1.005);MRSA (IRR=0.85, 95%CI:0.73-0.98). In states with prior HAI mandates, an increase of one standard deviation in HHI (reduced competition) is associated with 16.5% (p<0.001) higher rates of hysterectomy SSI and 9.9% (p=0.002) higher rates of CAUTI. State-based public reporting programs were associated with reduced infection rates for some but not all infection types. Such benefits appear to matter only in highly competitive markets; reductions in competition tend to attenuate the effects of public reporting.