Survey of Infection Control Experts Found that Certain Quality Metrics Are Seen as Low Value and Should Be Retired
Infections spread in hospitals and other healthcare settings cause over 680,000 infections and 72,000 patient deaths in the U.S. every year. Surveillance and reporting of these infections to government entities has become a key part of hospital infection control programs, yet infection control experts question the effectiveness of these measures at protecting public health. That is the finding of a new survey led by researchers at the University of Maryland School of Medicine. Results were recently published in the journal JAMA Network Open.
The UMSOM researchers analyzed results from survey respondents from 43 U.S. hospitals that are part of the Healthcare Epidemiology Research Network, a consortium focusing on research in infection control and antibiotic misuse. The respondents reported that many metrics, such as surgical site infections and antibiotic-resistant (MRSA) bloodstream infections, were important measures of infection control that should be reported to the federal government. The vast majority of respondents, however, said that two metrics -- related to sepsis management and ventilator-associated infections -- were not useful measures of infection control efforts.
“These infection control metrics are intended to reflect the quality of care at each institution, but some of the metrics don’t take into account the complex care provided by academic institutions as compared to community hospitals,” said study lead author Gregory Schrank, MD, Assistant Professor of Medicine at UMSOM and an infectious disease specialist at the University of Maryland Medical Center (UMMC). “Some have infections that can’t be prevented, while other metrics we are required to report aren’t indicative of an infection and don’t lead to an improvement in the quality of care that patients receive. Our survey found that tracking these metrics can detract from other important infection prevention work.”
Even more surprising, 84 percent of respondents said they believed hospitals and staff “intentionally manipulate” hospital-associated infection rates publicly reported on the government’s Centers for Medicare & Medicaid Services (CMS) Hospital Care Compare website. The federal government sets reimbursement rates for Medicare and Medicaid patients based on these metrics. Survey respondents stated that they feel pressure to find ways to avoid reporting cases.
“We found that survey respondents did not believe the metrics reported on these websites were well understood by the public,” said study co-author Daniel Morgan, MD, Professor of Epidemiology & Public Health at UMSOM. “They also did not think reimbursements should be tied to these metrics, given all the caveats to collecting and reporting them.”
While the study researchers pointed out that reporting of hospital-acquired infections has led broadly to an improvement in care, they concluded that the survey highlighted the need for adjustments to these metrics to create less of an incentive for hospitals to game the system.
“While requirements to collect and report hospital metrics were implemented with the best of intentions, improvements clearly can be made to the system,” said UMSOM Dean, Mark T. Gladwin, MD, who is also Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor. “For example, there is a need for a more robust use of risk adjustment tools in these models to create national benchmarks for hospitals that treat the most complicated cases and sickest patients.”
Other co-authors on this study who were UMSOM Epidemiology & Public Health faculty members include Surbhi Leekha, MBBS, Medical Director of the Infection Control Unit at UMMC, Jonathan Baghdadi, MD, Lisa Pineles MA, and Anthony Harris, MD, infectious disease specialist at UMMC. A researcher from VA Boston Healthcare System and Harvard Medical School was also a study co-author.
About the University of Maryland School of Medicine
Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu