Public disclosure of healthcare-associated infections: the role of the Society for Healthcare Epidemiology of America.

Prior to 2004, only two states, Pennsylvania and Illinois, had enacted legislation requiring healthcare facilities to collect nosocomial or healthcare-associated infection (HAI) data intended for public disclosure. In 2004, two additional states, Missouri and Florida, passed disclosure laws. Currently, several other states are considering similar legislation. In California, Senate Bill 1487 requiring hospitals to collect HAI data and report them to the Office of Statewide Health Planning was passed by the legislature, but was not signed into law by Governor Schwarzenegger, effectively vetoing it. The impetus for these laws is complex. Support comes from consumer advocates, who argue that the public has the right to be informed, and from others who view HAI as preventable and hope that public disclosure would provide an incentive to healthcare providers and institutions to improve their care. With these new state laws, the focus of attention is not directly on individual providers, but rather on healthcare facilities, which will be mandated to collect and report hospital-level performance indicators. The debate over public disclosure often pits consumers, insurance carriers, and health maintenance organizations (“the payers”) against healthcare providers. The payers want performance data made available so that they can be better purchasers of healthcare services. Healthcare providers are concerned that the data may be flawed and misleading. Personnel at healthcare institutions also are concerned about the additional cost for resources that will have to be expended to collect the required data. The stakes may be even higher because the results of these analyses can conceivably be used by health plans to choose among competing providers or incorporated into the reimbursement process (“pay for performance”). These laws mandating HAI reporting are not revolutionary, but are simply the latest development in the movement to improve the quality of medical care and to hold healthcare providers more accountable. The establishment of the Professional Standards Review Organizations (PSROs) in the 1970s was among the first attempts at legislating the quality of care.1 The goal of state and local PSROs was the review of the care provided by physicians in order to find “bad doctors.” The net value of such peer review was certainly questionable. Beginning in the early 1990s, the emphasis shifted away from individual case review toward identifying and promoting patterns of care (process indicators) that were associated with improved outcomes. In 1989, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), as part of its Agenda for Change, developed and field tested quality of care indicators, including infection control indicators, that hospitals would be required to collect in the process of seeking or renewing their accreditation.2,3 JCAHO’s