Maryland ties payment to hospital performance on hospital-acquired conditions

Results from a state-wide hospital-acquired conditions reporting program were published last week by the state of Maryland.  Hospitals were required to report data in 49 categories of potentially preventable complications including HAIs.  Of the 45 hospitals that submitted data, 9 hospitals had higher rates than the state's target.

Maryland is currently the only state that ties payment to hospital performance on dealing with hospital-acquired conditions.  The state sets target rates for each reportable condition and payments to hospitals are tied to meeting the state's targets.

In 2008, Maryland's hospitals collectively had approximately 53,000 cases of hospital-acquired conditions out of a total of 800,000 inpatients and these conditions amounted to approximately $500 million in potentially preventable hospital payments.  The initiative was put in place in 2009 in an effort to address hospital-acquired conditions and to improve the quality of care for patients.

More info can be found at the Maryland Health Services Cost Review Commission website

The Department of Human and Health Services (HHS) to make a $750 million investment in prevention and public health

HHS announced last week that it will invest $750 million in prevention and public health in fiscal year 2011.  The money will fund activities in four areas: Community Prevention ($298 million), Clinical Prevention ($182 million), Public Health Infrastructure ($137 million), and Research and Tracking ($133 million).

Among these four areas, the one that would likely to have the most direct impact on hospital associated infections is the last, Research and Tracking.  About $49 million of the $133 million will be spent on efforts that help the CDC to identify and disseminate evidence-based recommendations on important public health problems to  inform practitioners, educators, and other decision makers.  

Link to full article

Making the business case for infection control

Infection Control Today outlines the steps to help IPs make the business case to hospital executives. The first thing IPs need to do is to calculate the economic cost of hospital-acquired infections in their hospital by using the methodology described below:

1. Select one of the following options for the population to be analyzed:
a. Option 1 – select a number such as 10 patients who acquired a CLABSI
b. Option 2 – select a class of HAIs for the last year (include any case where a payor was billed for any service related to an HAI; do not include a case if the primary cause of admission was for an infection; do include re-admissions for HAI)

2. Identify the actual or estimated reimbursement for each case

3. Identify the total costs associated with the case, based upon activity-based cost accounting, if available

4. Identify the costs attributable to the HAI

5. Calculate the gross margin for the case by subtracting the expenses from the reimbursement

6. Compare the gross margin for the case to the gross margin of similar cases without an HAI, matched for age, principal diagnosis and admission severity

Once the economic costs are known the next step is to build the business case following the steps outlined by Dr. Eli Perencevich:
1. Frame the problem and develop a hypothesis about potential solutions
2. Meet with key administrators
3. Determine the annual cost
4. Determine what costs can be avoided through reduced infection rates
5. Determine the costs associated with the infection of interest at your hospital
6. Calculate the financial impact
7. Include the additional financial or health benefits
8. Make the case for your business case
9. Prospectively collect cost and outcome data once the program is in effect

Link to full article

February is my least favorite month, when winter has worn out its welcome and although spring is around the corner it is still halfway down the block.

To ward away the winter chill, I attended a lecture by John G. Thomas, Ph.D. at my regional APIC meeting last Friday. Dr. Thomas is a professor of microbiology at West Virginia University and one of the best speakers I have ever heard. He spoke to us about biofilms, not only giving an eye-opening description of what they are and how they work, but also presenting fascinating information about new lab techniques to identify them (think CAT Scans of specimens!).

During his live presentation we were able to see 3-D action shots of how biofilms develop. He also used his hand puppet sidekicks, Biofilm Bradford and Planktonic Phyllis. Brad and Phyllis demonstrated their unique roles in causing and sustaining infections. One process they are involved in is the Ping Pong cycle.

Rather than trying to summarize his presentation, I am giving you direct links to several of Dr. Thomas' web lectures. I can't say they are as entertaining as the live "show", but they give a lot of insight into the important role that biofilms play in the development and maintenance of infections, such as chronic wounds and VAP. (Trust me, you will never think of an endotracheal tube or a dressing the same way again.) One thing I am sure you will appreciate is that Dr. Thomas respects IPs as a vital part of the health care team.

If you have a limited amount of time to devote to these lectures, I suggest that you watch
Putting the Pieces Together: The Link Between Oral Care, Biofilms and

Pneumonia and Defining the Impact of Microbes in Chronic Wounds: A Biofilm Reactor.

Have patience with the information about dental plaque. You will understand how teeth play a role in infection long before they are decayed or missing.

Each item on the list below is a direct link to a web lecture with slides. To access the link, put your cursor over the title. It will change shape to a I. When this happens, right click and select "Open link" in a new window or new tab, whichever you prefer.

The Micro Mini Series

From Dr. Thomas: Welcome to the Micro Mini Series. Below you will find a series of 30 minute lectures on Biofilms and their importance in today's medicine. It is my hope that these lectures will help shed light on what a Biofilm is, and the risk it presents in today's medical environments.

#1 Biofilms: Architech of Survival

#2 Biofilms: Architech of Chronic Diseases Head to Toe

#3 A Comprehensive Engineered Ventilator-Endotrach-Lung (VEL) Model

#4 Diagnostic Microbiology, Pathology and Biofilms

#5 Rediscovering the Benefit of "Microbial Engineering": Probiotics

#6 Putting the Pieces Together: The Link Between Oral Care, Biofilms, and Pneumonia

#7 Defining the Impact of Microbes in Chronic Wounds: A Biofilm Reactor

#8 Prebiotics & Probiotics: Old Fad with New Interventions - NEW

#9 A Biofilms Procaryotic Tumors? Or... Are Tumors Eucaryotic Biofilms? NEW

Investigative reporting reveals dangers of HAIs in Las Vegas hospitals

Two reporters, Marshall Allen and Alex Richards, were tasked to investigate and report on the quality of hospital care in Las Vegas. After two years of extensive research, the Las Vegas Sun this month published their findings in a multi-series called, “Do No Harm: Hospital Care in Las Vegas.”

Allen and Richards dived deep into data that hospitals submitted to the state of Nevada (they obtained a record of every Nevada hospital inpatient visit going back a decade – 2.9 million in total) and what they found were both fascinating and alarming. For example, the rate of patients who contracted MRSA rose by 34% from 2008 to 2009 and that 2,010 patients were infected with MRSA and C. diff while hospitalized during the two-year period.

Here is a video summary by Brian Greenspun, editor and publisher of the Las Vegas Sun

Positive deviance leads to better hand hygiene compliance and lower infection rates

Last year, Ron wrote about the concept of positive deviance and how the concept can be applied in healthcare settings in order to improve quality of care. A study published in the February issue of the American Journal of Infection Control found that a positive deviance strategy on hand hygiene led to higher hand hygiene compliance and lower infection rates.

Researchers observed hand hygiene compliance using electronic handwashing counters, recording both the frequency of usage of alcohol gel dispensers and the total volume of dispensed alcohol gel during the study period. The positive deviance strategy for hand hygiene involved bi-monthly meetings with healthcare workers (HCWs) to discuss best practices. These sessions were led by positive deviants identified initially by the nurse managers and they were HCWs who were highly motivated to improve hand hygiene through new ideas. Positive deviants employed various methods to engage other HCWs during the meeting including the use of motivational techniques and videos.

During the 3 month study period, the total volume of alcohol gel dispensed per month was more than double the volume dispensed before the study began. Hospital acquired infection rates were also lower during the study period than before the study began. This study shows that positive deviance is an effective strategy for hand hygiene compliance and when used appropriately, can lead to much improved hand hygiene results. 

Link to full article