"It's hard for me to think of any industry that would tolerate not being paid on a system that's wrong more than it's right."Ĭurrently, hospitals providing this information are rewarded with a pay for reporting incentive of 2% of their Medicare reimbursement. Using administrative data, which has been done in the past, "gets it right about one in four times," Pronovost says. The NHSN data, for example, includes central line patients who had a fever. Rather than using administrative discharge codes to tell whether a patient developed a central line infection, which are sorely inaccurate, CMS and CDC are using a much more specific clinical definition of CLABSI, as reported by each hospital, and collected by the National Healthcare Safety Network. Nancy Foster, the AHA's vice president for quality and safety and Pronovost say they're particularly pleased because of the type of data that is now posted. It is funded with an $18 million contract from the federal Agency for Healthcare Research and Quality to the Health Research & Educational Trust, a non-profit research affiliate of the American Hospital Association. The effort continues to reduce infection rates by 50% as soon as possible. So for the public to see hospitals with rates as high as 3 (and 4), that would really say that, well, it would raise a concern about the commitment to safety at that hospital."Ībout one third of hospitals have enough cases so far to justify a rate, but in late April, another three months of data will be posted, and in July, another three months until all hospitals have enough cases to compare.įor those hospitals that do have enough data, those with over 1.0 SIR are worse than national average, and some are much worse, including 37 with scores above 2.0. With the exception of perhaps some burn units, which treat patients particularly vulnerable to infections, "we've seen rates come down in virtually every type of ICU. ![]() "It simply says there's not enough leadership attention being paid to this." "We've also seen a number of hospitals that started out high, but didn't come down, and the public ought to be aware of that," Pronovost warned. "Now, whole states have CLABSI rates (averages) less than 1."īut even as some hospitals showed success, others appear stymied. "Even in hospitals that were already hitting the benchmark, with rates of 1.1 or 1.5, many were able to cut them in half or more," Pronovost told me. Referring to a 750-hospital cooperative effort funded by the federal Agency for Healthcare Research and Quality, Pronovost talked about how hospitals proved that if they try, they can improve. It is, he said, "a bellweather for where the country needs to go in paying for outcomes" instead of process measures. "CLABSI is one of the most accurately measured outcome indicators-a canary in the coal mine for quality-because we see that when hospitals focus their efforts, they can make dramatic reductions in these infections." "It sure seemed like there needed to be something stronger that would say to a hospital, 'You know, you're a little above the average, or you're 10 times the national average. No economic incentive to improve," Pronovost said. "Other than media pressure (when a newspaper tackled CLABSI with a front page stories) there has been no other sanction. By allowing the public to view the worst and best and everyone in between, hospitals would be all the more stimulated to improve, raising the bar even higher, he told me. When I reached him at home earlier this week, Pronovost didn't hide his joy. ![]() Perhaps because of dramatic implementation of Pronovost's checklist, these numbers are a dramatic reduction from two years ago when the CDC estimated 248,000 CLABSIs a year with between 31,000 to 60,000 deaths and a cost of $2.7 billion.
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