More Data on Hospital-Acquired Infections, Please

Hospitals are dangerous places. Americans acquired 722,000 infections in a hospital setting in 2011, the most recent year cited by the Center for Disease Control and Prevention. About one out of twenty-five patients fell victim to preventable hospital-acquired infections.
In the interest of controlling infectious disease, health care officials have begun tracking the data more closely in recent years. In November the Virginia Department of Health published its Virginia-specific findings for 2015. Overall, hospitals in the Old Dominion compare fairly favorably with their peers nationally based on a methodology that adjusts for the acuity of patients and other relevant factors.
But that conclusion is tempered by (a) significant weak spots in Virginia hospital performance, and (b) the fact that the methodology compared only five categories of common infections, not all infections.
That said, here follow the statewide conclusions from the consumer version of the study based on 2015 data. Virginia hospitals exhibited:

• Fewer bloodstream infections than predicted based on the national experience in 2006-2008.
• Fewer urinary tract infections than predicted based on the national experience from 2009.
• More infections following abdominal hysterectomies and about the same number following colon surgeries based on the national experience from 2006-2008.
• Fewer methicillin-resistant Staphylococcus aureus bacteremia laboratory-identified events than predicted based on the national experience from 2010-2011.
• About the same number of hospital-onset Clostridium difficile laboratory-identified events as predicted based on the national experience from 2010-2011.

Bacon’s bottom line: As I argued previously, Virginia consumers/patients should have full transparency into the risks they are taking when they enter a hospital. When I wrote previously, I was unaware that the Virginia Department of Health collected the data. The department deserves kudos for publishing its report in a form comprehensible to the public. But it should go further.
The report lists every hospital in the state and gives it a green star (better than expected compared to national norms) a red X (worse than expected), an equal sign or a “No Conclusion.” This really isn’t very helpful. Does the Depaul Medical Center, to pick a random example, outperform national norms for bloodstream infections by a razor-thin margin or a wide margin? Do Virginia Commonwealth University patients undergoing colon surgeries experience many more infections or just a few?
More to the point, why doesn’t the health department tell us the total of all hospital-acquired infections at each institution and how the numbers compare to national norms?
It also would be helpful to get a sense of what’s happening to hospital-acquired infections over time. To pick an example, it’s nice to know that Virginians incurred fewer bloodstream infections in 2015 compared to the national baseline of 8- to 10-years previously. But that’s a long period of time. How much progress has been made? How rapid has the progress been — have Virginia hospitals made big gains, or are they doing only marginally better than a decade previously?
The cost of health care poses one of the greatest challenges to 21st-century American society. Eliminating hospital-acquired infections should be low-hanging fruit for controlling costs and improving medical outcomes. While Congress argues over Obamacare and the zero-sum question of who subsidizes whom, Virginia needs to take the lead in driving down costs and improving medical outcomes to the benefit of all. Greater transparency can help by making hospitals more attentive to patients’ concerns and by shining a spotlight on under-performers. If  hospital managements fear looking bad in the eyes of the public and its board of directors, they will make the control of infections a top priority.
(This First ran in Bacon’s Rebellion on Jan. 3, 2017)
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