1. Texas: Public Reporting of Healthcare- Associated Infections ? Susan Jones BA, MPH, M(ASCP), CIC, CHSP Infection Control Practitioner

2. OBJECTIVES Discuss history of public reporting in Texas Describe current legislation on public reporting in Texas

3. Not “New” to Texas 75 th Legislative Session HB 418: Reporting of quarterly and annual “hospital infection rates” – Filed 01/09/97 by Maxey – Read First Time 02/03/97 – Referred to Public Health 02/03/97 …

4. HB 418: Why Not Passed? “Hospital Infection Rate” – Numerator? – Denominator? – Definitions of Infection? – Targeted Surveillance? – Risk-Adjustment? A Different Time & Place

5. Since Then …A Storm Has Been A Brewing

6. A Different Culture from 1997 – 1999 -- IOM “To Err is Human” Report – Consumer Groups Leapfrog Consumers Union (Stop Hospital Infections) RID (Reduce Infection Deaths) – IHI Bundles Institute for Healthcare Improvement 100K Lives Campaign 79 th Legislative Session: 2005

7. SB 609 Filed by Nelson 02/21/05 Referred to Senate HHS 03/01/05 First Public Hearing 03/08/05 Got Out of Committee … Amendments Amendments Tabled Eventually added as an ‘amendment’ to the ‘niche hospital study bill’ SB 872

8. SB 872: What is the “Charge” Establishes a 14 Person Advisory Panel Submit 11/01/06 Report to the Commissioner and to the Presiding Officer of Each House – Advisory Panel’s Recommendations Infection Rates Process Measures Or, Both

9. HAI Advisory Panel Members TSICP is Involved – Patti Grant, Greg Bond, Susan Jones, Linda Watkins 4 ICP’s, CIC, hospitals (1 rural) 1 CEO of Hospital 1 CEO of ASC 3 Texas DSHS 2 Consumers 3 MD’s, Membership in SHEA

10. Texas HAI Advisory Panel Will file a report with – Formal Recommendations in Texas Format – Fiscal Note Inclusion – A lengthy evidence-based “White Paper” – Appendix Definition of ICP Definitions of Infection Infection Prevention Program ‘Scorecard’

11. HAI Advisory Panel Progress Voluntary Study of IC Programs in Texas sent to CEO’s: 437 hospitals & 274 ASCs – 37% (179/435) Response Rate for Hospitals – 13% (35/274) Response Rate for ASC’s – Large variety of customized programs – Provided Some ‘Insight’ into Current Texas Resources for IC&P Programs

12. Tentative Texas HAI Report …

13. Texas: Key Recommendations Data to help consumers make informed decisions for care related to HAI’s – Meaningful Data Comparisons Incentivize facilities to  HAI’s by doing high yield outcome measurement – Specific ‘apples to apples’ comparisons Reduce HAI costs and LOS

14. Texas: Key Findings Focus on Evidence-Based Outcome Measurement (Not Process) Rely on trained ICP’s to identify and report HAI data Texas DSHS provide ICP training on software reporting (qualified)

15. Texas: Key Findings Hospital Discharge Diagnosis Codes not Used to identify HAI’s for Public Reporting Focus on HAI type and data collection per evidence- based literature Must follow CDC NSHN Guidelines and Definitions

16. What’s Looking “A GO” for HAI Public Reporting RSV rates in pediatric populations -- Rate – Not “just” in Children’s Hospitals Surgical Site Infections – Patient Level Data – Mandated Post D/C Surveillance to Surgeons Central-Line Associated BSI -- Rate – Laboratory-Confirmed – Risk-Stratified by ICU Type – NICU stratified by birthweight

17. Safeguards to Culture Change Future Direction – More “Patient-Level” Data Confidentiality of Data – HIPAA Immunity Protections for Reporting – Litigation Data Validation – Power of Texas DSHS to Investigate

18. No Guarantee HAI Advisory Panel recommendations will become “Law”

19. What About The Entire USA? 2002 Only 2 states with HAI Public Reporting Activity As of 2006 the NQF has an entire project to identify a ‘consensus’ on what each state should be doing for public reporting of HAI’s … so can have state to state comparisons

21. WEBSITES Texas Legislature Line http://tlo2.tlc.state.tx.us Leapfrog http://www.leapfroggroup.orgttp://www.leapfroggroup.org Institute for Healthcare Improvement (IHI) http://www.ihi.org Reduce Infection Deaths (RID) http://www.hospitalinfection.org National Quality Forum (NQF) http://www.qualityforum.org