Wednesday, April 23, 2008

HHS Tracking Infections

HHS’s role in reducing the rates of Healthcare-associated Infections (HAI) was discussed at the House Oversight and Government Reform Committee hearing held on April 16, 2008 on Capitol Hill. Don Wright, M.D., M.P.H., Principal Deputy Assistant Secretary for Health at HHS, Office of Public Health and Science within the Office of the Secretary, outlined the various surveillance and monitoring systems now in place within the agency.

CDC is leading in several activities to track and prevent healthcare-associated infections. For example the National Healthcare Safety Network (NHSN) formerly the National Nosocomial Infection Surveillance System, is a web-based tool used by hospitals and state health departments to measure healthcare-associated infections. The system is maintained using the Public Health Information Network (PHIN) components and standards.

According to Dr. Wright, additional options for NHSN will be released in 2008 to help the states participating in NHSN measure MRSA among both inpatients and outpatients. Participation in NHSN has increased in the past few years, and the Network is expected to continue to expand to accommodate local, state, and federal reporting initiatives for healthcare-associated infections. CDC currently supports more than 1300 hospitals in 16 states using NHSN to fulfill state reporting requirements.

Dr. Wright explained that there are several other healthcare systems tracking infections by CMS, and AHRQ, plus joint efforts are taking place. For example, CMS is using several systems to report infection data. The Medicare Patient Safety Monitoring System identifies the rates of specific adverse events within the Medicare population using inpatient medical records and administrative data.

The CMS Reporting Hospital Quality Data for Annual Payment Update System has participating hospitals reporting on infection related measures with the data currently reported and available on the CMS Hospital Compare website. The data promotes value-driven healthcare and quality transparency by providing information from individual hospitals to the public.

CMS is currently evaluating replacing the current coding system ICD-9-CM with an updated system ICD-10 that should improve the collection of healthcare-associated infections data. Plans are for ICD-10 to be ready by 2011.

AHRQ is also involved in tracking infection data. The agency is able to obtain information on potential in-hospital complications and adverse events and can track variations in healthcare-associated infections across regions using Patient Safety Indicators (PSI). Through AHRQ partnership’s with 39 states in the Healthcare Cost and Utilization Project, data is now reported on 90% of the hospital discharges in the country. AHRQ can then track variations in healthcare-associated infections across regions and over time using PSIs.

Within the joint efforts taking place between CDC and CMS, the agencies are collaboratively working on a common set of data requirements for monitoring infections and adhering to prevention guidelines. CDC and CMS are working on data requirements to measure MRSA as part of CMS’s Ninth SOW for the QIO program. This should result in the wider use of NHSN by hospitals participating in the QIO program. Also, CDC and CMS are working on an agreement concerning monitoring surgical procedures that should be monitored as part of public reporting of surgical site infection rates.

GAO recently published the report “Health-Care-Associated Infections in Hospitals” that criticizes HHS efforts for having multiple programs collecting data on healthcare-associated infections. GAO reports that each of the databases that collect the information present only a partial view of the extent of the problem. GAO also reports that there are limitations on the scope of information that they collect plus there is a lack of integration across the databases. GAO wants to see linkages across the healthcare-associated infections databases to better understand where and how infections occur.