Part two of Marshall Allen and Alex Richards’ Las Vegas Sun hospital investigation series “Do No Harm” takes on hospital-acquired infections. Even though no agency in the state tracks such things, the duo managed to find 2,010 instances of drug-resistant bugs in local hospitals between 2008 and 2009. That number included 647 instances of hospital-acquired MRSA.
In the story, the explain how they overcame industry resistance to dig up the data themselves:
No health agency tracks these cases. In fact, hospitals derailed proposed legislation in 2009 that would have required them to publicly report cases of MRSA in their facilities.
However, hospitals are required by law to submit to the state billing records based on each patient visit. The Sun obtained that information from 1999 to 2009 and analyzed the 2.9 million hospital billing records as part of its two-year investigation, “Do No Harm: Hospital Care in Las Vegas.”
Because of how the records are coded, the Sun was able to identify the number of infections by the two bacteria, and for the years 2008-09 further identify the cases in which the records say the patients acquired the bacteria while hospitalized.
While it’s hard to put their numbers in a national context because of widely varying methods of measurement and reporting, the duo can say that such infections jumped 34 percent from 2008 to 2009. Allen and Richards then establish two facts:
Some institutions have developed ways to keep MRSA and friends under control.
None of those institutions are in Las Vegas, where inspections show that hospitals could be doing a lot more.
Efforts to force Nevada hospitals to disclose MRSA cases withered under heavy industry opposition, though the legislature is now considering a watered-down version that would not public the MRSA rates of specific facilities.
It’s worth noting that the paper has published responses from readers who have plenty of their own hospital horror stories. The website includes their input both in text and through excerpts of some of the voicemails Allen has received since the first part of the series was published. They are heart wrenching but serve as an excellent example of how reporters can involve readers in a project.
The numbers hold a few interesting subplots, any one of which would benefit from further exploration. Here are a few:
When you compare 2001 and 2007, private insurance paid for slightly fewer stays, while stays for Medicare and Medicaid were up,respectively, by 20.1 and 29.9 percent.
“From 2001 to 2007, the number of stays with a principal diagnosis of blood infection nearly doubled (97.1 percent; 675,400 stays in 2007).”
The cost of a hospitalization for intestinal infection jumped 148 percent, yet hospital stays for such infections were up only 69.5 percent.
“For four of the top ten conditions—blood infection, acute kidney failure, respiratory insufficiency, arrest, or failure, and skin and subcutaneous skin infections—the uninsured demonstrated greater increases in growth in total costs and number of hospital stays than the other three payer groups.”
Private insurance paid 55.7 more for C-section-related hospital stays over the study period, while Medicaid costs increased 95.1 percent for the same sort of visits.
Check pages seven through 10 for summary tables, including overall numbers and two tables of the ten conditions for which costs are increasing most rapidly.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Saying that “commitment to open government goes beyond the making of government-wide policy for the future,” the White House announced a number of “open government” initiatives on Tuesday.
The initiatives come with an “Open Government Directive” (PDF) from Peter Orszag, director of the White House’s Office of Management and Budget, that sets out steps toward creating a more open government and establishes deadlines for action:
Publish Government Information Online – Includes a requirement that each agency create an Open Government Web page within 60 days.
Improve the Quality of Government Information – Within 45 days each agency must designate an official to be accountable for the quality and objectivity of federal spending information
Create and Institutionalize a Culture of Open Government – Within 120 days, each agency will publish on its Open Government Web page an a plan about how it will improve transparency and public participation.
Create an Enabling Policy Framework for Open Government – Officials will review OMB policies to find impediments to open government and propose changes to increase openness.
The specific initiatives just announced come from all departments of the cabinet. One of the most notable is a hospital report card that will include raw data for veterans administration hospitals:
To empower Veterans and the public at large to track quality, safety, and access to Veterans Health Administration (VHA) facilities, the Department of Veterans Affairs is publishing hospital “report cards,” including raw data on care provided in outpatient and hospital settings, quality of care within given patient populations, and patient satisfaction and outcomes.
Other health-related initiatives include:
Department of Health and Human Services, Department of Agriculture, Department of Commerce, Department of Energy & the National Aeronautics and Space Administration: National Assets for High-Tech Economic Growth
Fledgling businesses need easier ways to identify and assess entrepreneurial opportunities that will create jobs and strengthen economic growth. Towards that goal, the National Institutes of Health (NIH) and Food and Drug Administration (FDA) in the Department of Health and Human Services (HHS), the Agricultural Research Service in the U.S. Department of Agriculture, the National Institute of Standards and Technology (NIST) in the Department of Commerce, the Department of Energy, and the National Aeronautics and Space Administration are increasing access to information on 1) new technologies available for commercial licensing, 2) Cooperative Research and Development (CRADA) awards and opportunities, 3) Small Business Innovation Research (SBIR) awards and opportunities, 4) Small Business Technology Transfer (STTR) awards and opportunities, and 5) projects sponsored through grants and contracts.
Department of Veterans Affairs: Geographic Distribution of Expenditures
The National Center for Veterans Analysis and Statistics will release three years of raw data on estimated annual VA spending in each county and congressional district. The data represent payments to Veterans and dependents, services provided to Veterans, and general operating expenses. These data will be used by state and local Veteran agencies, Veteran advocacy groups, and the public to compare to and plan for local Veteran needs. Making the raw data available will enable its combination with local-population and veteran-related data, fostering new knowledge and improved services for Veterans.
Department of Agriculture: Promoting a Healthier America To unleash innovative approaches to improving the health of America’s children, the Department of Agriculture is releasing nutrition data for over 1,000 commonly consumed foods and launching a national competition for creative, mobile and web-based games. The competition will challenge entrepreneurs, software developers, and students to leverage the newly released data to develop games to help children make healthy eating decisions.
Department of Labor: Keeping America’s Workers Out of Harm’s Way
For the first time, the Occupational Safety and Health Administration in the Department of Labor is systematically publishing employer-specific information about occupational fatalities online. Employers with reported fatalities will have an incentive to take steps to improve safety and prevent future accidents. In addition, responsible employers will be able to use the database to identify dangerous conditions and take proactive precautions.
Department of Veterans Affairs: Veteran Population Model
The Veteran Population Model – using combined data from the Department of Veterans Affairs (VA), Department of Defense (DoD), and Bureau of the Census – provides the official estimates and projections of the veteran population for each year from April 1, 2000, through September 30, 2036. Previously available only through predefined queries, access to the raw data will enable public and private-sector service organizations to incorporate VetPop data into their models to project future demand based on population and demographic estimates.
Q&A on achieving a more open government
Chief Technology Officer Aneesh Chopra and Chief Information Officer Vivek Kundra take questions on the directive and the move to a more transparent government.
On the Beat: Covering Hospitals: An innovative simulation guides you through the sources and resources you need to tackle the beat. You’ll tap into the same tools that you’ll use on the job, and you’ll have a virtual mentor to walk you through the maze of reports, statistics and sources. One story line teaches you about reporting on hospital quality
Investigating hospitals: Find stories with ready-to-use Hospital Compare data: AHCJ has made it easier for journalists to compare hospitals in their regions by generating spreadsheet files from the HHS database, allowing members to compare more than a few hospitals at a time, using spreadsheet or database software. AHCJ provides key documentation and explanatory material to help you understand the data possibilities and limits.
The whole thing is worth a read. In this excerpt Ornstein discusses how health journalists find stories:
Good reporters have a variety of sources of information. Reporters who routinely cover the hospitals in their communities should be constantly looking at state inspection reports, lawsuit data about payouts, their Joint Commission accreditation, and how they’re doing with their training program. All these types of things should be on the radar screen and monitored regularly. But nothing can replace talking to employees in the facilities and the patients that receive care there—trying to get an on-the-ground perspective.
In a companion piece, Wachter reflected on the role the media has played in shaking the medical profession out of a dangerous rut of complacency:
What do we need from reporters who cover the medical errors beat? … reporters need to know enough about error science that they appreciate the importance of searching for systems factors, without immediately zeroing in on more dramatic and obvious sharp-end errors. They need to get the facts right. And, while raising the appropriate concerns, they need to avoid sensationalism and place the error, or the topic, in broader context. When they do these things, they are providing a unique and critical service to patients and caregivers.