Public, patients have right to know hospitals' infection rates

Imagine moving your family into a town and being told the school's academic performance is not measured and that graduation rates are not released.

You are told that one cannot possibly compare the performance of students in southeastern Kentucky with those in the more affluent golden triangle. And then you find out the scholastic data is not even sent to the state for evaluation of the school's performance.

You would explain to the school official that the main purpose is to measure the student's progress so that each child can reach his greatest potential. Measurement allows exploration of why differences exist and helps motivate students to improve. Reporting the data allows the tracking of performance and a basis of reward or sanction.

Fortunately, our schools do not operate this way.

Our hospitals, however, do.

All health care organizations maintain confidential records that track the progress and outcomes of individual patients under treatment. These outcomes should be reported to various state oversight boards, and data that do not violate patient confidentiality should be made available to the public.

Major resources in public health are being mounted nationally to address health-care-acquired infection, which occurs in one in every 20 hospitalizations. Unfortunately, in Kentucky, only outbreaks, not individual infections, are reported, and from October 2009 to October 2010, only four outbreaks were reported in acute care facilities in Kentucky — no C. difficile or MRSA cases.

Although we're a nation of statistics gatherers, there is one glaring omission in this endless list of measurements: how safe our health care facilities are. These facilities are generally not open about their infection rates, thus not allowing any way to compare one facility to another. There is no meaningful system that allows patients to know the facilities' infection rates.

Health care facilities are reluctant to release this information to the public for a slew of reasons. They may be concerned about image, not wanting to scare patients away. Or there may be a mentality that infections are inevitable, so public reporting would only cause alarm about something that can't be prevented.

However, many of the nearly 2 million U.S. cases of health-care-acquired infections and 100,000 deaths associated with them are preventable.

Studies have shown a 70 percent reduction in central-line bloodstream infections in hospital intensive care units after adherence to guidelines.

Given the heavy toll in death and disability due to these infections, it is important for patients and communities to know how many are caused by resistant bacteria, how many are in the bloodstream and how many are in the lungs of patients on ventilators.

Control of this epidemic, which has spread beyond the facilities, will require community participation. Accurate data made public helps motivate and explain the need for participation.

As Dr. Daniel Varga from St. Joseph Health System has pointed out, "What is measured is managed; what is measured publicly is managed well." Internal improvement depends on external transparency, and both will create a shift toward greater patient safety. Health care systems are complex, and correction of many problems requires complete transparency within the facility. But that's nearly impossible without community awareness of the problem.

As a result of heightened public concern, legislation has been enacted in at least 27 states. Some of the elements that should ideally be included in any Kentucky legislation and regulations are:

■ Transparency and public reporting. Patients have the right to know how health care facilities rank with respect to other facilities, but more important, how the facility's rates are decreasing over time.

■ Urgency and timeliness. Health care facilities have a responsibility to learn from and correct their mistakes. This process should take place immediately after a health-care-acquired infection is found in the facility. Data on such infections should be publicly reported quarterly to allow consumers a fair chance at making timely comparisons of hospital infection rates and making more informed decisions.

■ Standardized reporting. Standard data on the infections that is easily understood by the public is important to assure comparability between hospitals and to reduce confusion associated with interpreting results.

■ Validity and trust. Data should be validated before public reporting. Patients expect health care facilities to be honest in their reporting of data.

■ Centrality and comparability. Reporting should be posted on a central, user-friendly Web site, allowing hospital comparisons.

Norton Healthcare and St. Joseph hospitals provide data of hospital acquired infections on their Web sites. If these hospital systems can do this, all hospitals in Kentucky can.