Healthcare Transparency, Quality Outcomes and Consumer Choice: The wheel is turning, and you can’t slow down
At the end of this year, Infection Prevention programs in the United States will wrap up a decade of nationwide public reporting of healthcare-associated infections (HAIs) via the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. 1 While the movement for greater transparency in health-related outcomes and disparate legislative mandates had percolated at the state level during the preceding decade the first reports of (at the time, intensive care unit only) HAIs in US Hospitals was released in 2011.
The motivations for public reporting of quality metrics were certainly multi-factorial. In 1999, the Institute of Medicine (IOM) released a ground-breaking report “To Err is Human” which showcased how adverse health effects, including HAIs were responsible for 44,000-98,000 deaths annually in the United States.2 In 2003, Consumers Union launched the Stop Hospital Infections campaign (now the Patient Safety Action Network) to push for laws advocating for transparency and public awareness of these events and to hold providers, and ultimately, institutions accountable for improving care.3 Implied with all this transparency was the presumption that if prospective patients could see the performance of their available healthcare options, they would choose to receive their care at the organizations with better quality metrics, thereby creating competition and ultimately motivation for all healthcare providers to invest and commit to performance improvement activities.
After a decade, have these well-intentioned motivations come to fruition? With regard to outcomes for acute care hospitals, between 2008 and 2016, central line associated bloodstream infections (CLABSI) dropped 50%; clinically relevant catheter associate urinary tract infections (CAUTI) decreased 25%; and a 13% reduction occurred in hospital onset methicillin resistant Staphylococcus aureus (MRSA) bloodstream infections between 2011 and 2014.4 These reductions were repeated in 2017 compared to 2016 (CLABSI 9%, CAUTI 5%, 1% surgical site infections (SSI), 8% MRSA bloodstream infections and 13% hospital onset Clostridiodes difficile (CDI)) 5. And again in 2018, when compared to 2017 (CLABSI 9%, CAUTI 8% and 12% hospital onset Clostridiodes difficile (CDI)) 6. While these metrics are imperfect, a reasonable person would conclude that progress has been made.
But what about consumer choice? If the data is publicly available, and the consumer is both motivated and willing to seek out and use the data to make decisions about future medical care, they may not necessarily understand the data they’re looking at. In 2015, researchers recruited 61 patients during their hospitalization at a large tertiary referral hospital.7 They randomized patients into two groups. One group reviewed quality metrics via the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. The second group of patients reviewed the same data presented in a more user-friendly “dot-rating” format (similar to what one might see on consumer review websites like Yelp or Trip Advisor). When the patients looked at HAI data and evaluations in Hospital Compare they misinterpreted the data 68% of the time. Even with the reformatted dot-ratings method this improved to a (albeit statistically significant improved) 44% failure rate. In both cases, only 10% of patients acknowledged using a website to compare hospitals, but 47% stated that a website for comparing hospitals would have been helpful in deciding on the choice for their current admission. Notably, at the time this research was conducted, Hospital Compare had been available to the public for ten years with HAI related data posted for nearly five.1
The data is out there but the knowledge may be lacking. In the next blog, we’ll examine what has filled this void and what consumers want.
- https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare Accessed 1/28/2020.
- http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf Accessed 1/27/2020
- https://advocacy.consumerreports.org/press_release/patient-safety-action-network-launched-to-mobilize-patient-voices-to-improve-care/ Accessed 1/28/2020
- https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html Accessed 1/28/2020
- https://www.cdc.gov/hai/data/archive/2017-HAI-progress-report.html Accessed 1/28/2020
- https://www.cdc.gov/hai/data/portal/progress-report.html Accessed 1/29/2020
- Improving the Understanding of Publicly Reported Healthcare-Associated Infection (HAI) Data. Infect Control Hosp Epidemiol. 2016 Nov;37(11):1349-1354. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849396/