Reduction in Infection Rates after Mandatory Hospital Public Reporting: Findings from a Longitudinal Cohort Study in Canada

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Background:
The role of public reporting in improving hospital quality of care is controversial. Reporting of hospital-acquired infection rates has been introduced in multiple health care systems, but its relationship to infection rates has been understudied. Our objective was to determine whether mandatory public reporting by hospitals is associated with a reduction in hospital rates of Clostridium difficile infection.

Methods and Findings:
We conducted a longitudinal, population-based cohort study in Ontario (Canada's largest province) between April 1, 2002, and March 31, 2010. We included all patients (>1 y old) admitted to 180 acute care hospitals. Using Poisson regression, we developed a model to predict hospital- and age-specific monthly rates of C. difficile disease per 10,000 patient-days prior to introduction of public reporting on September 1, 2008. We then compared observed monthly rates of C. difficile infection in the post-intervention period with rates predicted by the pre-intervention predictive model. In the pre-intervention period there were 33,634 cases of C. difficile infection during 39,221,113 hospital days, with rates increasing from 7.01 per 10,000 patient-days in 2002 to 10.79 in 2007. In the first calendar year after the introduction of public reporting, there was a decline in observed rates of C. difficile colitis in Ontario to 8.92 cases per 10,000 patient-days, which was significantly lower than the predicted rate of 12.16 (95% CI 11.35–13.04) cases per 10,000 patient-days (p<0.001). Over this period, public reporting was associated with a 26.7% (95% CI 21.4%–31.6%) reduction in C. difficile cases, or a projected 1,970 cases averted per year (95% CI 1,476–2,500). The effect was specific to C. difficile, with rates of community-acquired gastrointestinal infections and urinary tract infections unchanged. A limitation of our study is that this observational study design cannot rule out the influence of unmeasured temporal confounders.

Conclusions:
Public reporting of hospital C. difficile rates was associated with a substantial reduction in the population burden of this infection. Future research will be required to discern the direct mechanism by which C. difficile infection rates may have been reduced in response to public reporting.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Reduction in Infection Rates after Mandatory Hospital Public Reporting: Findings from a Longitudinal Cohort Study in Canada. PLoS Med 9(7): e32767. doi:10.1371/journal.pmed.1001268
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001268

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Zdroje

1. KellyCPLaMontJT 2008 Clostridium difficile—more difficult than ever. N Engl J Med 359 1932 1940

2. McDonaldLCOwingsMJerniganDB 2006 Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 12 409 415

3. GravelDMillerMSimorATaylorGGardamM 2009 Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis 48 568 576

4. PepinJValiquetteLCossetteB 2005 Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 173 1037 1042

5. KwongJCCrowcroftNSCampitelliMRatnasingamSDanemanN 2010 Ontario burden of infectious diseases study Toronto Institute for Clinical Evaluative Sciences

6. DubberkeERGerdingDNClassenDAriasKMPodgornyK 2008 Strategies to prevent clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol 29 Suppl 1 S81 S92

7. FungCHLimYWMattkeSDambergCShekellePG 2008 Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 148 111 123

8. HibbardJH 2008 What can we say about the impact of public reporting? Inconsistent execution yields variable results. Ann Intern Med 148 160 161

9. TuJVDonovanLRLeeDSWangJTAustinPC 2009 Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial. JAMA 302 2330 2337

10. MarshallMNShekellePGLeathermanSBrookRH 2000 The public release of performance data: what do we expect to gain? A review of the evidence. JAMA 283 1866 1874

11. SchaufflerHHMordavskyJK 2001 Consumer reports in health care: do they make a difference? Annu Rev Public Health 22 69 89

12. McKibbenLFowlerGHoranTBrennanPJ 2006 Ensuring rational public reporting systems for health care-associated infections: systematic literature review and evaluation recommendations. Am J Infect Control 34 142 149

13. Ontario Hospital Association 2009 Public reporting of Clostridium difficile frequently asked questions Toronto Ontario Hospital Association

14. 2010 Excellent Care for All Act, 2010. Legislative Assembly of Ontario Bill 46. Available: http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&Intranet=&BillID=2326. Accessed 8 June 2012

15. National Ambulatory Care Reporting System 2007 CIHI data quality study of Ontario emergency department visits for 2004–2005—executive summary Ottawa Canadian Institute for Health Information

16. LevyARO'BrienBJSellorsCGrootendorstPWillisonD 2003 Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol 10 67 71

17. DubberkeERReskeKAMcDonaldLCFraserVJ 2006 ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 12 1576 1579

18. ScheurerDBHicksLSCookEFSchnipperJL 2007 Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 135 1010 1013

19. DubberkeERButlerAMYokoeDSMayerJHotaB 2010 Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 31 262 268

20. ZegerSLLiangKY 1986 Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42 121 130

21. SchullMJStukelTAVermeulenMJZwarensteinMAlterDA 2007 Effect of widespread restrictions on the use of hospital services during an outbreak of severe acute respiratory syndrome. CMAJ 176 1827 1832

22. GilliganPHJandaJMKarmaliMAMillerJM 1992 Laboratory diagnosis of bacterial diarrhea. NolteFS Cumitech 12A: laboratory diagnosis of bacterial diarrhea Washington (District of Columbia) American Society of Microbiology

23. LoENicolleLClassenDAriasKMPodgornyK 2008 Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 29 Suppl 1 S41 S50

24. Ministère de la Santé et Services Sociaux du Québec 2009 Surveillance, prevention et controle des infections nosocomiales Quebec City Ministère de la Santé et Services Sociaux du Québec

25. Health Protection Agency 2012 March 15 Quarterly epidemiological commentary: mandatory MRSA, MSSA and E.coli bacteraemia, and C. difficile infection data (up to October–December 2011) London Health Protection Agency

26. FaberMBoschMWollersheimHLeathermanSGrolR 2009 Public reporting in health care: how do consumers use quality-of-care information? A systematic review. Med Care 47 1 8

27. Ontario Ministry of Health and Long-Term Care 2010 Patient safety indicator reporting [database]. Available: http://patientsafetyontario.net/Reporting/en/searchselection.aspx. Accessed 18 June 2012

28. Centers for Medicare and Medicaid Services 2008 August 4 CMS improves patient safety for Medicare and Medicaid by addressing never events Baltimore Centers for Medicare and Medicaid Services

29. MillerMGravelDMulveyMTaylorGBoydD 2010 Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis 50 194 201

30. GilcaRHubertBFortinEGaulinCDionneM 2010 Epidemiological patterns and hospital characteristics associated with increased incidence of Clostridium difficile infection in Quebec, Canada, 1998–2006. Infect Control Hosp Epidemiol 31 939 947

31. PolgreenPMYangMBohnettLCCavanaughJE 2010 A time-series analysis of clostridium difficile and its seasonal association with influenza. Infect Control Hosp Epidemiol 31 382 387

32. PoutanenSMSimorAE 2004 Clostridium difficile-associated diarrhea in adults. CMAJ 171 51 58

33. DellitTHOwensRCMcGowanJEJrGerdingDNWeinsteinRA 2007 Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44 159 177