According to a study by Johns Hopkins, just 21 states in the USA are required to report hospital data on surgical site infections publicly. Furthermore, even when this data is made public, it is usually difficult to access for individuals who could use it in order to make decisions regarding their medical care.
The study is published online in the Journal of Healthcare Quality.
Findings from the study indicate that the current system for reporting these vital measures of health care quality is not effective. According to the researchers, the only way to get a better understanding of how well hospitals are doing at preventing patient harm are national guidelines that require these vital measures to be disclosed.
A cheaper way to reduce measures, such as rates of surgical site infections, is to report accurate data on them, the researchers say.
By providing patients with access to this information, they can select hospitals with lower infection rates for certain operations, which means that hospitals with higher rates will have reputational and financial incentives to quickly identify methods to improve.
Lead researcher of the study Martin Makary, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine, said:
"A lot of information is not available to the public and, if it were, hospitals would be motivated to improve. Right now, a hospital can have high complication rates, high readmission rates and high infection rates, but because patients can't look up this information, they're essentially walking in blind."
According to Makary, 20 years ago rates of mortality from coronary artery bypass surgery varied considerably among hospitals in New York State. However, four years after the state required public reporting of death rates from the procedure, average hospital mortality rates decreased by 41%. Makary believes that one reason for this decrease is that "poorly performing hospitals had an incentive to look better to consumers making health care decisions."
The team estimate that surgical site infections cause over 8,000 deaths a year and occur in up to 25% of patients following major surgical procedures. Surgical site infections are more and more known to be largely preventable, and rates are therefore used as a surrogate measure of broader health care quality.
An announcement was recently made by The Centers for Medicare and Medicaid Services stating that hospitals will soon be required to report surgical site infection rates for select procedures, and that failing to do so will result in financial penalties.
However, Makary reveals that the requirement only covers a few procedures, and that wider reporting of complications will be voluntary to begin with. He explains that Medicare needs to rapidly expand the program as well as accelerate the transition to uniform public reporting for all hospitals.
Together with his colleagues, Makary discovered that only 8 of the 21 states that had laws regarding monitoring and reporting surgical site infections, made the information available to the public in an easy-to-access format. In addition they found that as of September 2010, 29 states had no laws on this topic.
The team also found that the public information only covered between 2 and 7 procedures:
- 7 states reported surgical site infection rates for coronary artery bypass graft procedures.
- 6 states reported rates for knee or hip replacement procedures.
- 2 states reported surgical site infection rates for colon surgery, which has the highest rates of surgical site infections in the USA.
- 1 state (Ohio) reported rates after gallbladder surgery, one of the most common surgical procedures performed in the U.S.
According to Makary, it can be impossible to make comparisons as states do not always report how the information should be gathered. Makary explains that hospitals that are more efficient at gathering data may be at a disadvantage, due to the lack of national standards, as their rates may seem higher than rates at hospitals that do not look for infection cases as rigorously.
"It is important to use a common method or at a minimum ensure common parameters, inputs and definitions are used. Without that, it is difficult for consumers, payers or regulators to compare infections within or across states. Unless we are comparing apples to apples, public disclosure has the potential to mislead patients instead of help them."
Written by Grace Rattue