Report Title:

Disclosure of Hospital Infection Rates

Description:

Requires hospitals to disclose rates of infection to DOH quarterly and annually. Ensures confidentiality of individual patient information. Creates advisory committee to assist the DOH. Provides penalties and requires director of health to adopt rules.

HOUSE OF REPRESENTATIVES

H.B. NO.

287

TWENTY-THIRD LEGISLATURE, 2005

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to disclosure of infection rates in hospitals.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that hospital infections are a little-known but deadly problem. Hospital infections are the sixth leading cause of deaths in the United States, claiming approximately ninety thousand lives each year, as estimated by the Centers for Disease and Control and Prevention. More Americans die each year from hospital-acquired infections than from auto accidents and homicides combined. About two million patients contract infections unrelated to their original condition during their stay in the hospital. One in every twenty people admitted to hospitals in America contract an infection while under care. Even though the problem has been well documented for many years, a 2003 New England Journal of Medicine article reveals that the risks of hospital infections have "steadily increased during recent decades." The Centers for Disease Control and Prevention also estimates that hospital-acquired infections add $5,000,000,000 annually to direct patient care costs.

However, although there is compelling evidence that public disclosure of hospital infection rates ultimately saves lives because of hospitals' response to increased public awareness, in most states, hospital infection rates are secret. Where states have reported mortality rates at specific hospitals, publicizing the information is credited with a significant drop in mortality rates. For example, New York collects and reports mortality rates following coronary artery bypass graft surgery identifying hospitals and surgeons. The reports have been credited with prompting a significant drop in mortality. Between 1989 and 1995, the first six years during which data were collected, death rates following coronary artery bypass graft surgery fell from 3.52 deaths per one hundred to 2.52. Even more striking, a few years after the report was issued, some of the worst hospitals turned their performance around completely. Pennsylvania saw similar results following the publication of its own coronary artery bypass graft surgery reports beginning in the early 1990s. Between 1991 and 1995, Pennsylvania documented a twenty-two per cent decline in death rates following such surgical procedures.

The purpose of this Act is to combat hospital-acquired infections by requiring public disclosure of hospital infection rates.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part   . HOSPITAL INFECTION RATES DISCLOSURE

§321-A Definitions. For purposes of this part:

"Department" means the department of health.

"Hospital" means an acute care health care facility licensed by the department of health under section 321-14.5 and includes freestanding ambulatory surgical facilities.

"Hospital-acquired infection" means a localized or systemic condition in a patient that:

(1) Results from adverse reaction to the presence of an infectious agent or its toxin; and

(2) Was not present or incubating at the time of the patient's admission to the hospital.

§321-B Hospital reports. (a) Each hospital in the State that is subject to licensure under this chapter shall collect data on hospital-acquired infection rates for the specific clinical procedures determined by the department of health, by adoption of rules in accordance with chapter 91, including the following categories:

(1) Surgical site infections;

(2) Ventilator-associated pneumonia;

(3) Central line-related bloodstream infections;

(4) Urinary tract infections; and

(5) Other categories as provided under section 321-C(e).

(b) Hospitals shall submit quarterly reports on their hospital-acquired infection rates to the department of health by April 30, July 31, October 31, and January 31 each year for the previous quarter. The department of health shall adopt rules in accordance with chapter 91 to prescribe the format in which reports are to be submitted. Data in quarterly reports shall cover a period ending not earlier than one month prior to submission of the report. Quarterly reports shall be made available to the public at each hospital and through the department of health. The first quarterly report shall be due on April 30, 2006.

If the hospital is a division or subsidiary of an entity that owns or operates other hospitals or related organizations, the quarterly report shall be for each specific division or subsidiary and shall not be an aggregate report for the entire entity system-wide.

§321-C Advisory committee. (a) The director of health shall submit nominees to the governor for appointment to an advisory committee that shall include:

(1) Representatives from public and private hospitals (including from hospital infection control departments);

(2) Direct care nursing staff;

(3) Physicians;

(4) Epidemiologists with expertise in hospital-acquired infections;

(5) Academic researchers;

(6) Consumer organizations;

(7) Health insurers;

(8) Health maintenance organizations;

(9) Representatives of labor organizations; and

(10) Purchasers of health insurance, such as employers.

The advisory committee shall have a majority of members representing interests other than hospitals. The members of the advisory committee shall serve without compensation but shall be reimbursed for expenses, including travel expenses, necessary for the performance of their duties.

(b) The advisory committee shall assist the department in the development of all aspects of the department's methodology for collecting, analyzing, and disclosing the information collected under this part, including collection methods, formatting, and methods and means for release and dissemination.

(c) In developing the methodology for collecting and analyzing the infection rate data, the department and advisory committee shall consider existing methodologies and systems for data collection, such as the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention, or its successor. In any case, the department's discretion to adopt a methodology shall not be limited or restricted to any existing methodology or system. The data collection and analysis methodology shall be disclosed to the public prior to any public disclosure of hospital-acquired infection rates.

(d) The department and the advisory committee shall evaluate on a regular basis the quality and accuracy of hospital information reported under this part as well as the data collection, analysis, and dissemination methodologies.

(e) The department, after consultation with the advisory committee, may require hospitals to collect data on hospital-acquired infection rates in categories additional to those set forth in section 321-B(a).

§321-D Department reports. (a) The department shall submit to the legislature annual reports summarizing the hospital quarterly reports and shall publish the annual report on its departmental website. The first annual report shall be submitted and published no later than January 31, 2007. The department may issue quarterly informational bulletins at its discretion, summarizing all or part of the information submitted in the hospital quarterly reports.

(b) All reports issued by the department shall be risk adjusted.

(c) The annual report shall compare the risk adjusted hospital-acquired infection rates for each individual hospital in the State. The department, in consultation with the advisory committee, shall make this comparison as easy to comprehend as possible. The report shall also include an executive summary, written in plain language, that shall include, but not be limited to, a discussion of findings, conclusions, and trends concerning the overall state of hospital-acquired infections in the State, including a comparison to prior years. The report may include policy recommendations as appropriate.

(d) The department shall publicize the report and its availability as widely as practical to interested parties, including, but not limited to, hospitals, providers, media organizations, health insurers, health maintenance organizations, purchasers of health insurance, labor organizations, consumer or patient advocacy groups, and individual consumers. The annual report shall be made available to any person upon request.

(e) No hospital report or department disclosure may contain information identifying a patient, employee, or licensed health care professional in connection with a specific infection incident.

§321-E Privacy. It is the intent of the legislature that a patient's right of confidentiality shall not be violated in any manner. Patient social security numbers and any other information that could be used to identify an individual patient shall not be released notwithstanding any other provision of law.

§321-F Penalties. A determination by the department of health that a hospital has violated this part may result in any of the following:

(1) Termination of licensure or other sanctions relating to licensure under this chapter; and

(2) A civil penalty of up to $1,000 per day per violation for each day the hospital is in violation of this part.

§321-G Regulatory oversight. The department of health shall be responsible for ensuring and enforcing compliance with this part as a condition of licensure under this chapter.

§321-H Rules. The director of health shall adopt rules in accordance with chapter 91 to implement the purpose of this part."

SECTION 3. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:

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