Special Report: Infection Control and Managed Care

Managed care structures facilitate infection control

System linkage may improve prevention

The switch from fee-for-service medical insurance to various types of managed care is opening up new opportunities for surveillance and prevention in an era of emerging infections, the Centers for Disease Control and Prevention reports.

The recently published update of the CDC emerging infections plan notes that "because of their structures, managed care organizations are in a good position to conduct surveillance, answer clinical research questions, and effect changes in medical practice (e.g., implementation of guidelines)."1 That benefit comes at a time when shortened hospital stays for some conditions have made it necessary to develop new ways to monitor nosocomial infections and other patient outcomes that do not become apparent until after discharge from the hospital, the CDC notes.

"Managed care is constantly evolving. It is hard to say where health care in this country is going to stabilize," says Susan Binder, MD, one of the primary authors of the emerging infections plan and associate director for medical science in the CDC division of parasitic diseases.

"But I think there are a lot of advantages to certain kinds of managed care," she adds. "For example, data and information are sometimes managed in a way that makes it very useful for studies and evaluation of important public health questions. Another issue is that if you can reach a large managed care organization, you can reach many more physicians with less resources than when you have providers scattered in fee-for-service arrangements."

Integration and linkage of data systems within and between managed care organizations are showing promise in projects under study by the CDC, adds Steve Solomon, MD, chief of special studies activity in the CDC hospital infections program.

"A lot of infection control and health epidemiology is about data and information," he says. "Not only to get the information, but use the information to really make changes. The advantage that managed care brings through integration [is that] your access to data improves. You can now get information on patients across the entire continuum of care."

The epidemiologist can track "covered lives" through a health care system, as opposed to the traditional hospital "where you only know that patient from the moment they enter to the moment they are discharged," Solomon notes.

Tracking SSIs through outpatient database

For example, the CDC is currently working with Harvard Pilgrim health plan in Boston on a project that shows promise for improved tracking of surgical site infections (SSIs) post-discharge, he says. Data are not yet available from the ongoing project, but Solomon says initial results indicate that SSIs can be identified successfully by tapping into outpatient data bases within a managed care system and by linking up with databases of other managed care organizations.

"A traditional area of need for infection control is identifying surgical site infections that are diagnosed after the patient leaves the hospital," he says. "They have done some fantastic work up there linking those databases. The ultimate goal, obviously, is that nobody gets lost to follow-up."

Greater access to databases under managed care can be followed by infection control interventions when problems are identified, he adds. Such interventions — whether changes to guidelines, practice, or policy — may then be implemented across more than one institution and can include multiple disciplines such as physicians, nurses, and pharmacists.

"The changes in the health care systems have a tremendous potential effect for the kind of things we do in infection control and health care epidemiology, and for the public health system in general," Solomon says. He adds: "It is not always a completely smooth road."


1. Centers for Disease Control and Prevention. Preventing emerging infectious diseases: A strategy for the 21st century. Overview of the updated CDC plan. MMWR 1998; 47(No. RR-15):1-14.