Less than half of all U.S. states require hospitals to make data on surgical infections public, and in states where disclosure is mandated, the information is often not easily accessible to patients who could use it to make decisions about their healthcare, according to a new study.
A study released March 16 by Johns Hopkins Medicine found that only 21 states require public reporting of hospital data on surgical site infections.
Reporting accurate data on quality measures such as rates of surgical site infections can be an inexpensive way to reduce them, the authors say in their study published online in the Journal for Healthcare Quality.
Surgical site infections occur in up to 25 percent of patients after major surgical procedures and are estimated to cause more than 8,000 deaths a year. The occurrence of such infections is increasingly believed to be largely preventable, and these rates are often used as a way to measure broader healthcare quality at medical institutions.
The Hopkins study suggests that individual, state-by-state systems for reporting surgical site infections aren’t working and that national guidelines overseeing disclosure would be able to better gauge how well hospitals are doing at preventing harm to patients.
“A lot of information is not available to the public and, if it were, hospitals would be motivated to improve,” says study leader Dr. Martin Makary, an associate professor of surgery at the Johns Hopkins University School of Medicine in Baltimore. “Right now, a hospital can have high complication rates, high readmission rates and high infection rates, but because patients can’t look up this information, they’re essentially walking in blind.”
As of September 2010, 29 states had no laws regarding the monitoring and reporting of surgical site infections, the study found. Of the 21 that did have such laws, only eight made the data publicly available in an easy-to-access format.
Out of those eight states, the data shared were still limited, covering between two and seven procedures. Seven of the eight states reported surgical site infection rates following coronary artery bypass graft procedures, six did so for knee or hip replacement surgeries, and two reported rates after colon surgery, which has the highest national rate of surgical site infections. Ohio was the only state that reported rates after gallbladder surgery, which is one of the most common surgical procedures in the country. The average time lag between collection and publication of data was six months, with a range of two to 11 months.
In their study, researchers argued that when patients have access to surgical site infection information and use it to make personal medical decisions, such as choosing hospitals with lower infection rates for certain operations, hospitals with higher infection rates will have both financial and reputational incentives to quickly find ways to perform better and target these infection rates.
One example of the impact of such transparency occurred in New York State two decades ago, Makary said. Rates of mortality from coronary artery bypass surgery varied widely among hospitals before the state began requiring public reporting of death rates from the procedure. Four years after the mandatory reporting requirements went into effect, average hospital death rates from the operation fell by 41 percent. Makary says the reason for that drop was likely because hospitals that were performing poorly had an incentive to improve care.
The Centers for Medicare and Medicaid Services recently announced that hospitals must soon report surgical site infection rates for select procedures. If hospitals fail to meet certain benchmarks, they will suffer financial penalties. But the new requirement covers only a small number of procedures and wider reporting of complications will initially be voluntary. Makary says Medicare needs to quickly expand the program and speed up the transition to uniform public reporting for all hospitals.
Makary also says that states don’t always specify how data are to be collected, which results in disparate reporting that can make comparisons difficult. The lack of national reporting standards for surgical infections could also be a disadvantage for hospitals that are better at collecting information, because their rates may appear higher than those at hospitals that don’t look as rigorously for infection cases.