Freeing the data

"As a country, we have a health–care system that's been largely unaccountable to the public it serves," says Leah Binder, CEO of the Leapfrog Group. "The federal government has been very timid about requiring public reporting of key indicators of performance in hospitals, including infection rates."

For example, the federal Centers for Disease Control and Prevention has been collecting and analyzing infection data from hospitals since the early 1970s. But the 1,500 or so reporting hospitals participate—some voluntarily and some because their state governments make them—under an assurance of strict confidentiality.

Another federal agency, the Agency for Healthcare Research and Quality, collects data from hospitals in 42 states and uses the information to track trends in quality, costs, and utilization. But it reports its findings only in the aggregate, without naming any names. And in the private sector, hundreds of hospitals affiliated with academic medical centers share information, including patient–safety data, as part of a consortium.

In short, "most hospitals already have this information, but if they never put it together for the public in a meaningful way, it might as well not be there," said Lisa McGiffert, who heads Consumers Union's Safe Patient Project, which aims to stop preventable medical errors, including hospital infections.

But the culture of secrecy is starting to crumble, as evidenced by the fact that in 27 states, hospitals either already report infection rates or will eventually have to under new laws. Five years ago, only four states did.

That's excellent progress, but some states are lagging in getting their reporting systems up and running at all, and others are too slow in getting hospitals' reports out to the public, McGiffert said.

The national health–reform legislation under debate as this issue went to press contains provisions to require hospitals to report infections publicly. Consumers Union played a leading role in getting those provisions included.

And Daniel Pollock, M.D., surveillance branch chief in the CDC's division of health care quality promotion, told us that his agency is talking seriously with the federal Centers for Medicare & Medicaid Services (CMS) about having hospitals publicly report their infection data on Hospital Compare, a consumer–oriented government Web site that reports how well hospitals provide recommended care to their patients.