Abstract
The role of public reporting in improving hospital quality of care is controversial. Reporting of hospital-acquired infection rates has been introduced in multiple health care systems, but its relationship to infection rates has been understudied. Our objective was to determine whether mandatory public reporting by hospitals is associated with a reduction in hospital rates of Clostridium difficile infection. We conducted a longitudinal, population-based cohort study in Ontario (Canada's largest province) between April 1, 2002, and March 31, 2010. We included all patients (>1 y old) admitted to 180 acute care hospitals. Using Poisson regression, we developed a model to predict hospital- and age-specific monthly rates of C. difficile disease per 10,000 patient-days prior to introduction of public reporting on September 1, 2008. We then compared observed monthly rates of C. difficile infection in the post-intervention period with rates predicted by the pre-intervention predictive model. In the pre-intervention period there were 33,634 cases of C. difficile infection during 39,221,113 hospital days, with rates increasing from 7.01 per 10,000 patient-days in 2002 to 10.79 in 2007. In the first calendar year after the introduction of public reporting, there was a decline in observed rates of C. difficile colitis in Ontario to 8.92 cases per 10,000 patient-days, which was significantly lower than the predicted rate of 12.16 (95% CI 11.35-13.04) cases per 10,000 patient-days (p<0.001). Over this period, public reporting was associated with a 26.7% (95% CI 21.4%-31.6%) reduction in C. difficile cases, or a projected 1,970 cases averted per year (95% CI 1,476-2,500). The effect was specific to C. difficile, with rates of community-acquired gastrointestinal infections and urinary tract infections unchanged. A limitation of our study is that this observational study design cannot rule out the influence of unmeasured temporal confounders. Public reporting of hospital C. difficile rates was associated with a substantial reduction in the population burden of this infection. Future research will be required to discern the direct mechanism by which C. difficile infection rates may have been reduced in response to public reporting. Please see later in the article for the Editors' Summary.
Highlights
The past decade has witnessed a remarkable global surge in the incidence and severity of Clostridium difficile infection [1,2,3,4]
Public reporting of hospital C. difficile rates was associated with a substantial reduction in the population burden of this infection
Future research will be required to discern the direct mechanism by which C. difficile infection rates may have been reduced in response to public reporting
Summary
The past decade has witnessed a remarkable global surge in the incidence and severity of Clostridium difficile infection [1,2,3,4]. This pathogen has long been among the most burdensome hospitalacquired infections, but has become a leading contributor to infectious disease morbidity and mortality in developed countries [5]. C. difficile bacteria cause diarrhea and, more rarely, lifethreatening inflammation of the gut (colitis) They are present in the gut of about 3% of adults but do not normally cause any problems because other ‘‘good’’ bacteria keep them in check. Infections can be prevented by practicing good hygiene in health care environments (for example, washing hands regularly with soap and water), by isolating patients who are infected with C. difficile, and by prescribing antibiotics for other infections sparingly
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