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Background
For over 15 years, public disclosure of hospital outcome data has been thought to improve patient safety. 1 One of the most serious issues for ensuring patient safety is preventing healthcare associated infections (HAIs); at any given time, an estimated 1 in 25 hospitalised patients in the USA has a HAI, leading to significant morbidity and mortality. 2 The Centers for Disease Control and Prevention (CDC) estimated the annual national hospital costs of HAI to be US$25-31 billion. 3 These data, coupled with growing demand for transparency and accountability by policy makers, have led several countries to legally mandate the public reporting of HAI indicators including England, France and the USA. 4
In the USA, HAI reporting laws have been enacted at the federal and state levels. 5 6 In 2008, the federal Department of Health and Human Services implemented a national Action Plan for reducing HAIs across healthcare and identifying measureable goals. 7 In support of the Action Plan, further federal initiatives were legislated. For example, as part of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5, 42 U.S.C 241(a)), US$40 million were appropriated through the CDC. These funds were available to all states to support state departments of health (DOH) for HAI prevention planning and infrastructure including supporting a state-specific dedicated programme coordinator (HAI coordinator). As part of the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148), the Hospital Value Based Purchasing Program built on earlier legislation that allowed Medicare to pay hospitals for reporting quality measures, rather than on the quantity of care (eg, service or patient counts). This programme included the Inpatient Quality Reporting Program requiring hospitals to report specific HAIs to the CDC's National Healthcare Safety Network to receive full Medicare payment.
The federal laws apply across all 50 states and provide incentives only; these interventions do not mandate action. As of 2013, 37 states (including the District of Columbia and Puerto Rico) have introduced laws that require facilities to report HAI indicators to each state's DOH, which then may report HAI data publicly. 8 While there is support of the general concept of HAI prevention, the evidence on the benefits of public reporting has been inconclusive and opinions are mixed. 9 10...