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State health department disavows accuracy of its own report on hospital infections
BY STEVEN MAYER, Californian staff writer
smayer@bakersfield.com | Friday, Jan 07 2011 04:15 PMLast Updated Friday, Jan 07 2011 04:15 PM
Two years ago most hospital administrators began reporting their hospital-acquired infection rates to state health officials, as required by a new state law.
And in the waning days of 2010, state health officials made those numbers public.
There's only one drawback.
The raw numbers are just this side of worthless.
"We accept the blame," said Mike Sicilia, a spokesman for the state Department of Public Health, the state agency responsible for collecting, verifying and publishing the numbers of patients who contract four types of infections -- and in which hospitals the infections occurred.
Although most believe the report is a good first step in publicly reporting the incidence of hospital-acquired infections, public health officials have not been cagey about what they say are "significant limitations" in regards to the quality and completeness of the numbers.
"There's a lot of raw data, but it's not risk-adjusted," Sicilia said.
And that can skew the results.
For example, Shriners Hospital for Children in Sacramento appears to have the highest rate of infections in the Sacramento area, according to the raw data. But Shriners performs procedures and treats more patients that present higher risks of certain types of infections, Sicilia said.
Although the reporting period began in January 2009, the health department was not budgeted to staff the program until nearly a year later. Additionally, the department only had a minimal system in place to receive the infection-reporting forms.
Because the law allowed hospitals to submit the data in one of two ways -- on paper or electronically -- there was no consistency. The department also acknowledges that it had no quality-assurance process in place to review and correct data errors, and hospitals were not able to verify their data close to the time of public release.
An estimated 200,000 hospital-acquired infections and 12,000 related deaths occur statewide each year.
Medical consumer advocates have argued for years that making the incidence of hospital-acquired infections available to the general public -- including singling out hospitals by name -- will compel patient-care facilities to reduce the number of infections and give consumers critical information about the hospitals in their communities.
After being given more than two years to prepare, the first wave of reports on the state's 373 general acute-care hospitals was released to the public Dec. 30, just two days before the Jan. 1 deadline.
But California's first stab at providing everyday residents with the long-awaited statistics is far from perfect and anything but user-friendly, say consumer advocates.
"Navigating the reports is not easy; that's one of our biggest complaints," said Lisa McGiffert, director of Consumers Union's Safe Patient Project.
Going public with these numbers will reduce infection rates, McGiffert said, because it forces hospitals to create a system that searches for and documents infections.
Many hospitals were said to have provided incomplete statistics, although the state's flawed records-gathering system even places that in doubt.
And what about the 20 hospitals -- including three in Kern County -- that the state said didn't provide any numbers at all?
"We're in touch with all those hospitals," Sicilia said.
According to the reports, Kern Medical Center, Kern's county-owned hospital, did not provide infection numbers. Delano Regional Medical Center and Good Samaritan Hospital in Bakersfield were also on the list of hospitals that did not report.
But that information also appears to be in question.
Kern Medical Center Chief Executive Paul Hensler said the county-owned hospital has been providing data all along as required. And while KMC's reports were not included in the public release, Hensler instructed staff to immediately forward KMC's raw data to The Californian. Unfortunately, the data received so far included just one of the four infection types.
"The idea of keeping and reporting the data I think is good," Hensler said. "If you don't measure it, you can't improve."
Kathie Wright, a spokeswoman for Delano Regional Medical Center, also said the hospital has been providing the infection numbers.
"We've been reporting monthly," Wright said. "We're absolutely required by law to do this."
While the Consumers Union's McGiffert acknowledged the data needs more context, she said the early numbers are still valuable. Consumers can look at the sample size to avoid making grossly unfair comparisons, she said.
Nevertheless, the state must do a better job of collecting and verifying the data.
"All of this is self-reported by hospitals," McGiffert said. "I don't think we can trust that. I feel confident that many infections that occurred did not get reported."
Meanwhile, McGiffert said, Consumer Reports, a sister organization to Consumers Union, is working to compile the data in a more user-friendly format. Whether such a format change can overcome the still-emerging problems with the raw data remains to be seen.
State Public Health Director Dr. Mark Horton said in a statement that the effort, though flawed, represents "a first step toward closer monitoring of these infections in hospital settings and more robust public reporting."
Given all of the limitations of the data, "these data cannot be used for comparisons between hospitals," Horton said.
The department's Sicilia said the bugs are already being worked out of the reporting system.
"We believe next year's report will be much better," he said.
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California has mandated that all hospitals begin reporting ALL infections and for the information to be made public. January 1, 2011, the first report came out. As could easily be predicted, the information is incomplete, fragmented, and hard to sort through. However, I still stand up in applause for this initiative. There are still many steps to be taken in this process. But the hardest part, getting the ball rolling forward (overcoming the inertia) has been overcome. Now hospitals are getting in the mode of reporting infections, no matter how it makes them look. Now, analysts can begin reviewing the data. Now, we can see how to make the process better. This is going to lead to 1000's of hospital-borne infections being eliminated annually.
One of healthcare's biggest issues is grappling with the idea of transparency. From pricing, to reporting errors, to scheduling of patient visits, hospitals and staff are very nervous to change. I dont blame them - they are thinking about their patients and the hospitals' reputations. Change is difficult for everybody. But in any industry, in any walk of life, transparency always leads to an overall improvement in logistics, pricing, and operations. It is what helped the airline industry become the safest industry in the world.
Hospitals are on their way with their transparency and lean movements. I am looking forward to see seeing hospitals delivering even better care.
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