To gauge hospital quality, patients deserve more outcome measures

Patients, providers and the public have much to celebrate. This week, the Centers for Medicare and Medicaid Services’ Hospital Compare website added central line-associated bloodstream infections in intensive care units to its list of publicly reported quality of care measures for individual hospitals.

Why is this so important? There is universal support for the idea that the U.S. health care system should pay for value rather than volume, for the results we achieve rather than efforts we make. Health care needs outcome measures for the thousands of procedures and diagnoses that patients encounter. Yet we have few such measures and instead must gauge quality by looking to other public data, such as process of care measures (whether patients received therapies shown to improve outcomes) and results of patient surveys rating their hospital experiences.

Unfortunately, we lack a national approach to producing the large number of valid, reliable outcome measures that patients deserve. This is no easy task. Developing these measures is challenging and requires investments that haven’t yet been made.

The addition of bloodstream infections data is a huge step forward. These potentially lethal complications, measured using Centers for Disease Control and Prevention’s methods, are among the most accurately measured outcomes. In addition, the science of how to significantly reduce these infections is mature, and hundreds of hospitals of all types and sizes have nearly eliminated them. A program to reduce these infections that started at Johns Hopkins Hospital was spread throughout Michigan, and is now being implemented throughout the U.S., demonstrating substantial reductions.

Achieving these results isn’t easy. It requires hospital CEOs to commit to a goal of zero infections, as well as unit and infection prevention leaders to work together to meet that goal. ICU clinicians need to take ownership of this campaign, recognizing that bloodstream infection measures are a canary in the coal mine—an indicator of how well a quality improvement system is functioning.

Prior to adding bloodstream infections to Hospital Compare, the public had patchy information regarding hospitals’ infection rates. A handful of states made the data public and in those that did, we noticed a concerning trend. While most hospitals achieved reductions, a small number had high rates and failed to improve.

This is largely from lack of leadership focus, not because their patients are sicker and more susceptible to pathogens. In our national work focusing on bloodstream infections, we have seen that all types of hospitals and ICUs can dramatically reduce rates (though burn ICUs have higher rates than others).

Now that the public has data on bloodstream infection rates, let’s hope they use it, and let’s hope we finally create a mechanism to develop the many other measures that patients deserve. The key is to ensure that the measures are valid and that they tell the whole story. Our past research has revealed that “the more you look, the more you find” for certain complications, such as harmful blood clots. We don’t want hospitals to look worse than others in the public eye simply because they worked harder to identify when their patients were being harmed.

Public reporting has risks, and it can do more harm than good when the wrong measures are used. Though bloodstream infection rates are not a perfect measure, they perform well. Given that these infections kill approximately 30,000 people each year in the U.S. (slightly fewer than the number of people who die from breast or prostate cancer) and they are almost entirely preventable, they have not received the attention they deserve. The Hospital Compare website can help shine a light on those hospitals that need to redouble their efforts.

What should patients do with this data? First, if they think they may end up in an ICU, they should investigate the infection rates of their local hospitals. If a hospital has a high rate, they should discuss it with their physician and weigh the risks and benefits of seeking care elsewhere. Even if you are not seeking care and your local hospital has a high rate, write to the hospital’s CEO and board of trustees to ask what they are doing to reduce these infections, to honor their commitment to serve the community.

Bravo CMS, let’s hope this trend continues.

Note: Due to a technical glitch, bloodstream infection data for The Johns Hopkins Hospital was not immediately available on Hospital Compare, but it will be in the future. In the meantime, bloodstream infection data is available via the Maryland Health Care Commission at this link.

Read a related article on this new CMS measure.