Washington state has solidified its position as a leader in health data transparency with the publication this year of hospital surgery infection rates. The data is broken down hospital-by-hospital and includes numbers for the rates of certain infections following cardiac surgery, orthopedic surgery and hysterectomy, as well as for compliance with infection prevention numbers. For more numbers, including some which have been published for several years now, visit the state hospital association’s transparency center.
The Wall Street Journal‘s Katherine Hobson writes about the recent JAMA study which she says demonstrates that publicly reported infection control measures, including checklists, “don’t actually correlate with post-op infection rates.”
The study was designed to evaluate the six infection control measures tracked by the Surgical Care Improvement Project. Those measures include everything from antibiotics to hair removal and blood glucose levels.
None of those measures correlated with infection rates individually, Hobson writes, but when taken in aggregate things start to look a little better.
Study lead author Jonah Stulberg, a recent graduate of Case Western Reserve University School of Medicine (where the research was conducted) tells the Health Blog that the score is called an “all-or-none” composite, which is like a pass/fail: The hospital gets credit for a particular patient only if all the appropriate measures are taken.
With the statistics out of the way, Hobson addresses the biggest question: Why aren’t these prevention measures making a difference in the real world? The answer, as it always seems to be in these situations, is that life is complicated and human beings aren’t robots.
… there’s a big difference between a practice being proven to be effective in a clinical trial and then developing a measure that tries to estimate how often it’s done and then report it publicly.” Real life is messier, and factors such as surgical skill and hand-washing practices are tougher to measure.
Dale Bratzler, CEO of the Oklahoma Foundation for Medical Quality, tells the Health Blog the results don’t surprise him. Individual process of care measures for things such as heart attack and pneumonia also haven’t been shown to correlate with outcomes, he says.
Scott Hensley runs NPR's online health channel, Shots. Previously he was the founding editor of The Wall Street Journal's Health Blog and covered the drug industry and the Human Genome Project for the Journal. Hensley serves on AHCJ's board of directors. You can follow him at @ScottHensley.
The Veterans Affairs health system may be a model for electronic medical records and savvy drug purchasing, but all bets are off when it comes to the disinfection of equipment for colonoscopies.
After reports of problems piled up, the VA inspector general did some surprise inspections at the government-run hospitals and found they weren’t doing a good enough job sterilizing endoscopes. Yesterday, congressmen blasted the VA for not fixing the problems even after it became aware of them.
“The failure of medical facilities to comply on such a large scale with repeated alerts and
directives suggests fundamental defects in organizational structure,” said the report by the VA OIG. Inadequate cleaning of the equipment may have exposed more than 10,000 vets to hepatitis B, hepatitis C or HIV.
The Tennessean has a handy chronology of the colonoscopy controversy and a recent story with reactions from affected patients. “There’s nothing they can say,” said Thomas Mayo, a 58-year-old Vietnam vet who learned in February that he has hepatitis C. “They’ve given me something that may kill me.”
For more, see testimony by the VA in this Associated Press video.