Download HAIidew01-09(2) - Texas Department of State Health Services

Update SB 288: Health Care
Associated Infections
Infectious Disease Epidemiology Workgroup
Jan. 9, 2009 Austin, Texas
Gary Heseltine MD MPH
Infectious Disease Control Unit
“When speculation has done its worst, two and two
still make four.” Samuel Johnson, The Idler
SB 288 Mandatory Public Reporting of
Healthcare-associated Infections
80th Regular Legislative Session 2007
• Hospitals, Ambulatory Surgical Centers (ASCs) to report
specific HAIs to DSHS using CDC case definitions
• Must begin no later than 6/1/08
• Minimum once per year, maximum each quarter
• Must contain sufficient patient ID data
– avoid duplication
– verify accuracy and completeness
– allow for risk adjustment
• DSHS will review data for validity and “unusual data
patterns or trends”
SB 288 Advisory Panel Activities
Sixteen member Advisory Panel– two year term
• Six meetings in 2008
• Recommended use of NHSN for reporting
– ASC not supported by NHSN
– Public reporting remains problematic
• Letter to commissioner stressing funding
• Talking points developed for legislature
Adult Reportable SSI Infections
•
•
•
•
colon surgeries
hip and knee arthroplasties
abdominal and vaginal hysterectomies
CABG and vascular procedures
Pediatric Reportable SSI Infections
•
•
•
•
Cardiac procedures excluding thoracic cardiac
VP shunt procedures
Spinal surgery with instrumentation
And (non-SSI) respiratory syncitial virus infection
Reportable Central Line Infections
Lab confirmed from a patient in any “special care setting
in the hospital”
Alternative Reporting
For facilities with an average < 50 procedures/monthly
Report SSIs related to the 3 most frequently performed
procedures from the National Healthcare Safety Network
(NHSN) procedure list
Intersecting Activities Outside
DSHS
• DHHS action plan for HAI
– Seven metrics identified including MRSA and C
diff infections
– SCIP data already reported via Hospital
Compare
• CMS non-reimbursement for “never events”
– Will not pay for increased costs
– Private insurers follow suit
– Importance of POA diagnostic codes
Intersecting Activities Outside
DSHS con’t
• TJC patient safety goal 7
– Focus on epidemiologically important MDROs
– Implement best practices preventing CLBSI,
SSIs and measure
Conclusion
Multiple partial overlap with SB 288
Need for uniform case definitions and ability to share data
Need to harmonize demands placed on facilities for reporting.
Unified Approach to Quality and
Patient Safety
Validated
Data
Standardize
d data
formats
Harmonized
Standards
and
Guidelines
Integrated Data
Reporting on
Enhanced Web
Site
Improved
Performance
Rewarded
(P4P)
Improved
Provider
Performance
Unified
Approach to
Regulation
• Integrate existing and proposed data reporting
initiatives
• Increase compliance with harmonized standards
• Reduce burden and cost for providers and state
through unified approach to regulation
• Improve quality while reducing cost through improved
provider performance and reimbursement incentives
Reporting Mechanism
• Plan A: Missouri Healthcare System
– Associated Infection Reporting System- large IT project
• Plan B: National Health care Safety Network
– initially viewed as complex and burdensome to ICP
– currently recommended by HAI panel
– DSHS build IT system to receive/display NHSN data
• Plan C: Use Texas Hospital Discharge Data Network
– Already reaches statewide except rural hospitals and will be expanded
to all ASCs under existing legislation
– Problems include data definitions, legal ability to share, contracts
• Plan D – as needed
• Option for public to report suspected HAIs to DSHS
– Poses significant challenges, particularly validation
SB 288 Funding
• For FY 2008 DSHS requested $4.5M, 36 FTEs
– LBB calculated $1.1M and 5 FTEs
• FY 2009 DSHS requested $3.7M
– LBB calculated $1.2M and 8 FTEs
• Other scenarios presented
Current status = not funded
Presented as an exceptional item
What is the best investment for Public Health?