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Facility-Specific Employee Influenza Vaccination Data for 2008-09: Options and Considerations for Public Postings PowerPoint PPT Presentation


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Facility-Specific Employee Influenza Vaccination Data for 2008-09: Options and Considerations for Public Postings. Kate Cummings, MPH Healthcare Associated Infections Program California Department of Public Health. Goals of the Ideal Mandatory Reporting & Disclosure Program 1.

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Facility-Specific Employee Influenza Vaccination Data for 2008-09: Options and Considerations for Public Postings

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Facility specific employee influenza vaccination data for 2008 09 options and considerations for public postings

Facility-Specific Employee Influenza Vaccination Data for 2008-09: Options and Considerations for Public Postings

Kate Cummings, MPH

Healthcare Associated Infections Program

California Department of Public Health


Goals of the ideal mandatory reporting disclosure program 1

Goals of the Ideal Mandatory Reporting & Disclosure Program1

Maximize accuracy of data collection

Standardize methodology for data collection and analyses

Minimize costs to hospitals and governmental agencies

Produce data that are valid, fair to hospitals, and useful to consumers

1 Edmond MF In: Hospital Infections, 5th ed., 2007.


Cdc healthcare infection control practices advisory committee hicpac 1

CDC Healthcare Infection Control Practices Advisory Committee (HICPAC)1

“Mandatory public reporting…is intended to enable stakeholders, including consumers, to make more informed choices on healthcare issues”

Public reports must

Convey scientific meaning in a manner that is useful and interpretable to diverse audiences

Must clearly communicate limitations of data and methods

Data should be assessed for validity/precision prior to release

1 Guidance on public reporting of health-care associated infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee Am J Infect Control 2005;33:217-26


Selected assumptions underlying public reporting 1

Selected Assumptions Underlying Public Reporting1

Publicly reported healthcare quality data are valid

Consumers will use publicly reported data

Consumers are willing and able to change their site of care

Consumers who use publicly reported data will make decisions that will improve their care

Market forces derived from public reporting will provide incentive for hospitals to improve quality

Positive outcomes will outweigh negative unintended consequences

1 Edmond MB, Bearman GML, Mandatory Reporting in the US, an Example to Follow? J Hosp Infect 2007Jun;65 (2):182-8.


Opportunities

Opportunities

Vaccination of health care personnel has been proven effective1

The measure is unambiguous1; does not require risk adjustment

Public reporting may increase vaccination rates (no published information on effectiveness)

1 Guidance on public reporting of health-care associated infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee Am J Infect Control 2005;33:217-26


Potential constraints

Potential constraints

“Developers of reporting systems should avail themselves to established and proven methods of collecting and reporting surveillance data…… publicly reported HAI rates can mislead stakeholders if inaccurate information is disseminated….”

1Guidance on public reporting of health-care associated infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee Am J Infect Control 2005;33:217-26


What is surveillance

What is Surveillance?

The ongoing systematic collection and analysis of data and the provision of that information for use in disease prevention and control.


Established surveillance methods

Established surveillance methods

Clear goal (s)

Clear, uniform case definition (s)

Case ascertainment (case-finding) with consistent inclusion and exclusion criteria

Consistent surveillance catchments (population under study)

Standardized data collection and reporting instruments

Data quality assurance

Analytic strategies that address limitations to ensure appropriate interpretation

Disseminate results


Interpreting facility specific comparisons

Interpreting Facility-Specific Comparisons

Once posted, consumers must consider whether facility-specific percentages differ:

Distortion (systematic error)

Chance (precision)

Truly different

Present percentages in a way that discloses potential limitations and allows appropriate interpretation


Option 1 publicly post a report of state level data only

Does not draw attention to facility-specific rates but overall picture of the state

Data are older - may not represent the facility real time; limitations may affect validity

Less likely to have unintended consequences associated with inaccurate information

No access to facility-specific rates to inform healthcare decisions

Are consumers likely to use reported data to make healthcare decisions?

Are consumers able to choose site of care?

No public/market forces to provide incentive for hospitals to report accurate, timely data or improve vaccination rates

Option 1: Publicly Post a Report of State Level Data, Only

Pros

Cons


Option 2 publicly post facility specific data listed in alphabetical order

Access to facility-specific rates to inform healthcare decisions

May create public/market forces to provide incentive for hospitals to report accurate, timely data or improve vaccination rates

Because of data limitations, positive outcomes may not outweigh negative unintended consequences

Data limitations become amplified at the facility-specific level

Example: misclassification can falsely decrease or increase the rate

Inaccurate data may mislead consumers

Option 2: Publicly Post Facility-Specific Data Listed in Alphabetical Order

Pros

Cons


Option 3 publicly post facility specific data listed in rank order by percentage vaccinated

Rank is clear including outliers

Target goals or benchmarks are noted

California average

The Healthy People 2010: 60%

The proposed HP 2020: 90%

Facility rates to inform healthcare decisions

May create public/market forces to provide incentive for hospitals to report accurate, timely data or improve vaccination rates

Attention to outlier facilities

May be misclassified as an outlier in either tale due to data limitations previously described

Because of data limitations, positive outcomes may not outweigh negative unintended consequences

Option 3: Publicly Post Facility-Specific Data Listed in Rank Order By Percentage Vaccinated

Pros

Cons


Option 4 publicly post no data

Option 4: Publicly Post No Data

Ensures no unintended consequences associated with reporting inaccurate information

Consumers and other stakeholders will have no information

No public/market forces to provide incentive for hospitals to report accurate, timely data or improve vaccination rates

Pros

Cons


Facility specific employee influenza vaccination data for 2008 09 options and considerations for public postings

The 2008-09 data were not collected using established surveillance methodology and may not be valid

Data limitations impact facility rates; this affects our options for public reporting

Opportunities outweighed by potentially harmful unintended consequences?

misleading consumers, misdirecting quality improvement efforts, loss of credibility and public trust, diversion from true mission

Strongly consider releasing only aggregate data with full disclosure of limitations without specifying facility specific rates

Future data must be collected using standardized methodology

Given limitations, consider using 2008-09 as a test year; use lessons learned to plan for future data

Summary


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