Consumer Reports ready to take ICPs for a spin

Will your hospital measure up on infection rates?

In a strategy somewhat reminiscent of the state-by-state battle to get needle safety laws enacted, consumer advocates are taking their cry for open hospital infection rate reporting to one legislature at a time.

Pennsylvania and Illinois have enacted laws, and bills are under discussion in a variety of other states. The advocacy group behind the push is Consumers Union, the Washington, DC-based publisher of Consumer Reports.

The group has developed model legislation that can be tailored to individual states when their legislatures are in session. Of course, the aforementioned battle for state needle safety laws eventually resulted in federal legislation. Is that ultimately the strategy behind the state campaigns?

"We are looking at national efforts in collecting quality of care information," says Lisa McGiffert, one of the principals in the infection rate campaign and a Consumers Union regional official
in Austin, TX. "We are having discussions with some of them about including hospital-acquired infections in some of their report cards. We are also asking the Centers on Medicare & Medicaid to include hospital-acquired infections in their quality initiatives."

Asked about infection control professionals, she has an interesting answer that suggests the ultimate goal of all parties essentially is the same.

"We would like them to be our allies," explains McGiffert. "Frankly, we are not passing judgment on anyone. What we want is for the public to know how [hospitals] are doing. We think there are experts on infection control who know better than we do how to improve things. But the public has
a right to know if what they are doing is working. Our ultimate goal is to reduce hospital infections. We believe disclosure to the public is a way to do that."

Though noting that the reaction of ICPs to the campaign has ranged from supportive to defensive, McGiffert says the larger problem appears
to be lack of administrative support for programs in hospitals. "You have to have the commitment from the top down, a commitment in philosophy, practice, and money. A lot of infection control practitioners are operating in a situation that is not ideal."

Still, discussions of reporting infection rates remind some of previous efforts — such as release of mortality data — that made some hospitals look worse because they treated the sickest patients.

Health care epidemiologists warn of what William Scheckler, MD, of St. Mary’s Medical Center in Madison, WI, once described as "toxic data" — infection rates thoroughly confounded by a host of variables yet raised as a black flag over a "bad" hospital.

To prevent that, McGiffert says the consumer group is advocating state laws that would release infection rates according to standardized definitions and risk adjustments for patient severity of illness. "In all the states where we are working, a major part of it is a standardized way to collect and report. That is true of any quality measures that you report. You have to have standardization. That’s a given. We have heard that argument, but we are asking for standard [definitions]." Another misconception is that the campaign is seeking disclosure of one overall infection rate per facility, she adds.

"You wouldn’t have one rate for the hospital. You would have rates for types of infections and they would have to be risk-adjusted. The risk adjustment would be different for catheter-related and surgical-site infections [for example]. So when we say, rates,’ a lot of people misunderstand and think we mean one rate per hospital. We have learned that is not really going to be the thing that is going to be the most meaningful. We want to have different categories of rates," McGiffert says.

It has been half seriously suggested by some that hospitals eventually will be ranked with the little circles or dots used in the consumer group’s well-known reviews of automobiles. "I am personally not a fan of that for hospitals," she says. "When you look at the Consumer Reports model, it is more than dots; you get lots of information. We have had quite a few discussions in a number of arenas about how to present this information to the public. It is difficult, but we resisted the [rating] stars here in Texas [on hospital report cards]. We feel that simplifies it too much."

As the controversy plays out in various states, Pennsylvania may prove to be an early indicator of how such systems will be contested and implemented. (See Hospital Infection Control April 2004 under archives at www.HIConline.com.) The state hospital association argued there that the requirements be limited to nosocomial infections that represent the highest risk to patients and result in highest costs. As a result, the state pared down a mandate for reports of 14 infections to these key four: surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. Hospitals also were being granted time extensions beyond the original June 30, 2004, deadline for submission of data. Though conceding it was pushed back from its goal, the union accepts the result as something of a victory.

"We did feel that there was some ground lost in Pennsylvania in the final action," McGiffert says. "But in general, we are not unhappy with what Pennsylvania has done. They have gotten a really good start and they have the opportunity to expand on it later."