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Consumers Union (CU) supports public disclosure of healthcare-associated infections so that consumers can choose the safest hospital, and hospitals will have an incentive to improve. However, systems are not in place nationwide to ensure that these reports are as accurate as possible. Significant underreporting of medical harm, including infections, has been identified by numerous studies. Numerous factors contribute to inaccurate reporting, including: lack of knowledge and training on complex definitions, reporter misconceptions, poor documentation, human error, inadequate hospital resources, lack of commitment to accurately report, and failure of hospitals to create comprehensive internal hospital systems for accurate reporting. Further, public disclosure puts pressures on facilities to improve safety, which in some circumstances can lead to manipulation of the results. All of these factors can erode the public’s confidence and trust in health care providers and highlight the need for data validation.
The Safe Patient Project of CU has worked to raise public awareness, draft model legislation, and initiate state legislation for public reporting of HAIs. The Project and a network of local patient safety consumer advocates are responsible for greatly expanding the number of states with public reporting laws, which eventually convinced federal agencies to expand this reporting to most U.S. hospitals. Consumers expect publicly reported data to be accurate; the CU model legislation required checks on accuracy. However, failure to validate should not delay infection reporting as only the use and disclosure of data on HAIs will compel the system to work toward accuracy. While some states have initiated validation programs, few resources have been available for this activity. The lack of widespread standardized external data validation is a missing element needed to assure data credibility and comparability across settings. Validation must be transparent to all parties and comprehensive enough to focus facility attention on reduction of HAIs and not just the appearance thereof.
CU will discuss the consumer perspective on validation efforts; the role of states, CMS and hospitals in funding these efforts; validation standards to ensure public confidence; how validation of HAIs can establish a model for other types of medical harm; and possible strategies to respond to facilities with consistently inaccurate reports.