142nd APHA Annual Meeting and Exposition

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311648
Impact of state mandatory public reporting on hospital-acquired infection rates

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Zhiqiu Ye , Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
Yue Li, PhD , Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
Helena Temkin-Greener, PhD , Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
Many states have enacted laws mandating public reporting of hospital-acquired infections (HAIs) before the recent universal requirement by the Centers for Medicare and Medicaid Services (CMS). However, little is known about the value of these state laws. We examined whether hospitals in states with prior public reporting (at least one year prior to CMS’s mandate) have lower infection rates than in states without, and whether such differences depend on market competition.

We analyzed 3286 eligible acute care hospitals reporting HAIs to CMS between April 2012 and March 2013. Hospital-specific infection rates were obtained for:  central-line associated bloodstream infections (CLABSI), two surgical site infections (SSI), catheter-associated urinary tract infections (CAUTI), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium difficile (C.difficile). Hospital-level negative binomial regression models were fit for each infection type, controlling for state laws, the interaction with market competition measured by the Herfindahl-Hirschman Index (HHI) and other hospital characteristics.

In highly competitive markets, hospitals in states with prior public reporting have significantly lower infection rates only for the following HAIs: SSI on hysterectomy (IRR=0.85, 95%CI:0.74-0.98);CAUTI (IRR=0.88, 95%CI:0.78-1.005);MRSA (IRR=0.85, 95%CI:0.73-0.98). In states with prior HAI mandates, an increase of one standard deviation in HHI (reduced competition) is associated with 16.5% (p<0.001) higher rates of hysterectomy SSI and 9.9% (p=0.002) higher rates of CAUTI. State-based public reporting programs were associated with reduced infection rates for some but not all infection types. Such benefits appear to matter only in highly competitive markets; reductions in competition tend to attenuate the effects of public reporting.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Discuss the impact of state mandatory public reporting on hospital-acquired infection rates and whether such impact depends on market competition

Keyword(s): Health Law, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary researcher of this study under the supervision of my mentors, Helena Temkin-Greener and Yue Li.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.