Tuesday, April 13, 2010

2009 AHRQ National Healthcare Quality Report: Getting Worse(r)

AHRQ just published the "2009 National Healthcare Quality Report and National Healthcare Disparities Report" and things don't look too good. Full reports available here. Post-op sepsis or BSI---increased 8%. Post-op catheter-associated UTI---increased 3.6%. And for CLABSI - drum roll----no change. Ouch! Post-op pneumonia down 12%. The New York Times seemed upbeat, calling the problem of these infections "largely solvable."

I'm not sure where these data leave us and perhaps Mike, Dan and Connie will have some comments on this report too. However, I think what these data are telling us is that when you don't fund enough proper studies (and multiple studies) on methods to prevent HAIs - the 6th leading cause of death and when you are mostly left to resort to "absence of evidence-based medicine" tricks like kitchen-sink bundles...well, this is where you end up.

To suggest, as Katherine Sebelius did, that the new health care law would “help turn these numbers around” since hospitals with high rates of infections will be penalized starting in the 2015, is a bit hopeful. I think we haven't invested in HAI prevention studies like we have in cardiology and other areas, and I don't think we're going to get these rates down with sticks alone. You can't see in the dark if you don't know how to make a flashlight or even light a fire.

2 comments:

  1. I think there are 2 major problems with this report and its overall conclusion that HAIs are increasing:
    (1) as far as I can tell, it relies exclusively on administrative data; (2) it doesn't include any data from 2008 and 2009, the years likely to show the greatest impact of the work hospitals have been doing.
    I would wager that if we could see the trends through 2009 using NHSN data, obtained utilizing a methodology specifically designed to detect HAIs, the conclusion of the story would be just the opposite.
    So I would argue that these data were collected in the dark. Nonetheless, this report might help to wake up some laggard hospitals that have not begun to invest in the resources necessary to reduce HAIs.

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  2. I agree with Mike. However administrative data, when current can provide a good snapshot of what is happening. In California we compiled administrative date on discharged patients with a diagnosis of MRSA infection. Between 2005 and 2007 the numbers were stable at about 52000 each year. The 2008 unpublished data results were impressive. The number of cases declined to about 36,000. Now this is not good epidemiology however it does indicate that something is happening. That may be better outpatient treatment to avoid hospitalization or it could be as Chip Chanbers indicated at the SHEA conference that the incidence of CA-MRSA is waining.

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