States' HAI Reporting Comes of Age, Leaves Unanswered Questions

Healthcare-acquired infections (HAIs) are among the leading causes of death in the United States, accounting for 99,000 deaths annually. They affect patients, healthcare systems and society by increasing the cost of treating infections and causing greater disability and death. Since 2005, the number of states with laws requiring healthcare facilities to report HAIs has grown from six to 27.

Despite this activity, Ramanan Laxminarayan, director of the Extending the Cure Project (a project of the Center for Disease Dynamics, Economics and Policy, funded in part by the Robert Wood Johnson Foundation) says the effect state laws have on the number of HAIs remains unclear. Do hospitals comply with the laws? Does reporting affect HAI rates? Are some laws more effective than others?

The answers to these difficult questions may lie in a new report from the National Conference of State Legislatures (NCSL), State Public Reporting of Healthcare-Associated infections: Lessons from the Pioneers. As Laxminarayan notes in the report, Most states that have passed laws are just beginning to receive the first round of data from hospitals. Legislation is still new and not enough data have been collected to fully determine the laws effects. But as more states consider new or revised HAI-related laws, they still want guidance and information on the lessons learned by other states. This report, which is based on conversations with people involved with the formation and implementation of HAI laws in nine states, focuses on what states have learned while crafting and implementing HAI-related laws. We plan to investigate the outcome of these laws do they affect HAI rates and, if so, how much? in a few years when more states have several years of data. Until then, this report provides much-needed insight into the actions states can take to limit HAIs.

Legislators are always considering how to enhance the quality of life for the states citizens while efficiently, effectively and frugally using taxpayer money, especially during the current economic environment, says Rep. Peggy Welch, RN, chair of the NCSL health committee. In the light of these objectives, federal and state legislators have been focusing on HAIs that create pain and suffering for citizens while unnecessarily spending public funds.

At the heart of public reporting is the belief that promoting transparency will improve quality of care, expand and improve infection prevention measures, reduce the morbidity and mortality associated with HAIs, and cut costs. Setting up a reporting program is complex and time-consuming, however, and a successful program must have skilled staff and adequate, sustainable financing. NCSLs report shows how states are working through the challenges of establishing meaningful, effective initiatives.

In 2009, the American Recovery and Reinvestment Act (ARRA) authorized $50 million in funding for states to engage in HAI planning and other activities, including public reporting. Forty-nine states, the District of Columbia and Puerto Rico received grants.

The NCSL asserts that developing meaningful reporting programs is particularly challenging, and explains, For example, some infections are easier to report objectively than others, and billing codes alone may not accurately detect HAI cases. States may overcome some of these challenges by requiring facilities to report HAI data through the National Healthcare Safety Network (NHSN), a surveillance tool administered by the Centers for Disease Control and Prevention (CDC), which enables facilities to report HAIs according to standard, scientifically robust methodologies. The national surveillance system, however, is not obstacle free. First, enrollment in NHSN is a multi-step process that involves a learning curve for facility staff. In addition, reporting through NHSN can disproportionately strain infection prevention resources in some facilities, particularly in smaller and rural hospitals.

Common themes that the NCSL encountered through interviews with politicians and stakeholders included the difficulty of developing meaningful, effective reporting initiatives; the advantages of incrementally phasing in reporting requirements; the benefits of establishing a multi-disciplinary, multi-stakeholder advisory committee to help develop the reporting program (an approach that enables policymakers to build on their states unique circumstances and existing quality improvement activities); the importance of providing enough funding to carry out reporting initiatives; and the significance of recent federal guidance and funding to ensure that stakeholder support and financial resources are available to implement reporting laws.

To access the full report, CLICK HERE.

Reference: Spencer A, Sward D and Ward J. Lessons from the Pioneers: Reporting Healthcare-Associated Infections. National Conference of State Legislatures report. July 2010.