Hospital Compare Platforms
Hi all,
Vermont has a platform called Hospital Report Card that can be thought of as a state-level version of CMS' Hospital Compare. Act 53 (18 V.S.A. § 9405b) sets what hospitals are required to report for display on Hospital Report Card. My understanding is that each state has something equivalent (e.g., CompareMaine, New Hampshire Hospital Scorecard). I have a couple questions for you all related to this.
To what extent (if at all) are each of your HAI programs involved in this process? Our Hospital Report Card is not entirely HAI focused, but it does show some HAI/patient safety measures. Our Hospital Report Card team is in the process of considering measures to be added or removed (as stated in Act 53) and is asking for HAI program input.
For our non-critical access hospitals, most of the HAI measures we're displaying on Hospital Report Card are already required to be reported to NHSN by CMS, so this results in minimal new work for them. However, that's not the case for our CAHs, which are actually the majority here (8/14). So what I'm really trying to do, and what I'm hoping those of you who have been involved in this process can comment on, is build a strong case for which measures are important enough (from our HAI program's perspective) to make this request of our CAHs. At the same time, we're taking a critical look to see if any measures should be removed (resource expenditure outweighs benefit). At this time CLABSI, CDI, SSI: HYSTO, SSI: HPRO, and SSI: KPRO are required HAI measures per Act 53.
I appreciate any insight you have!
Best,
Will
Vermont has a platform called Hospital Report Card that can be thought of as a state-level version of CMS' Hospital Compare. Act 53 (18 V.S.A. § 9405b) sets what hospitals are required to report for display on Hospital Report Card. My understanding is that each state has something equivalent (e.g., CompareMaine, New Hampshire Hospital Scorecard). I have a couple questions for you all related to this.
To what extent (if at all) are each of your HAI programs involved in this process? Our Hospital Report Card is not entirely HAI focused, but it does show some HAI/patient safety measures. Our Hospital Report Card team is in the process of considering measures to be added or removed (as stated in Act 53) and is asking for HAI program input.
For our non-critical access hospitals, most of the HAI measures we're displaying on Hospital Report Card are already required to be reported to NHSN by CMS, so this results in minimal new work for them. However, that's not the case for our CAHs, which are actually the majority here (8/14). So what I'm really trying to do, and what I'm hoping those of you who have been involved in this process can comment on, is build a strong case for which measures are important enough (from our HAI program's perspective) to make this request of our CAHs. At the same time, we're taking a critical look to see if any measures should be removed (resource expenditure outweighs benefit). At this time CLABSI, CDI, SSI: HYSTO, SSI: HPRO, and SSI: KPRO are required HAI measures per Act 53.
I appreciate any insight you have!
Best,
Will
Comments & Events
Yvette Perron,
NH HAI Surveillance Coordinator
Hi Will,
Here in New Hampshire, all hospitals need to report CLABSI, CAUTI, SSI (CABG, COLO, HYST, KPRO), CLIP, Influenza Vaccination Rates, and Facility Influenza Vaccination Policies on a quarterly basis. Most of these metrics are required to report into NHSN by CMS. The items that are not submitted through NSHN, we collect through an annual survey.
The HAI program sends out quarterly reports, to help facilities QA their data. The data is then entered into an annual report which includes a facility report card. The report cards are also sent to hospital CEOs. The facility report card is 2 pages for most facilities. Specialty Hospitals only have a 1-page report card. It includes facility information, SIRs, rates, bar graphs and data notes.
Some hospitals do not perform all the reportable metrics. If a hospital does not perform the reported procedure, we write “Facility does not perform this procedure” on the report card. If the facility performed less than 20 procedures or less than 50 central line/catheter days we will censor the data.
Our specialty hospitals (rehab hospitals, mental health hospitals) receive a report card reflecting influenza vaccination data. There is a table that compares the facility influenza vaccination rates to the State. We include a bar graph of their rates over time. Finally, we include a table that addresses their influenza vaccination policy requirements.
Here is the link to our most recent report. The report cards can be found at the end. https://www.dhhs.nh.gov/dphs/cdcs/hai/documents/hai-2017-hospitals.pdf
We also create these report cards for Ambulatory Surgical Centers as well.
Please let me know if you have any additional questions.
Thank you,
Yvette
William Fritch
This is hugely helpful. Thank you, Yvette! We're in the early stages of planning for report generation and distribution as you describe here, but I think that some of our conversations have been fairly siloed. By that, I mean we've been planning for how we'll use TAP Reports on one hand, how we can use HCP flu vax data in another meeting, etc. The report cards you're generating are a good reminder to consider a more holistic approach!