Chapter
097
2008 -- S 2382 SUBSTITUTE A
Enacted 06/26/08
A N A C T
RELATING TO HEALTH
CARE QUALITY -- MONITORING THE OCCURRENCES OF HOSPITAL ACQUIRED INFECTIONS IN
HEALTH CARE FACILITIES
Introduced By: Senators Gallo, P Fogarty, and C Levesque
Date Introduced: February 12, 2008
It is
enacted by the General Assembly as follows:
SECTION
1. Sections 23-17.17-2 and 23-17.17-6 of the General Laws in Chapter 23-
17.17
entitled "Health Care Quality Program" are hereby amended to read as
follows:
23-17.17-2.
Definitions. -- (a) "Clinical outcomes" means information
about the results
of
patient care and treatment.
(b) "Director" means the director of the department of health or his
or her duly
authorized
agent.
(c) "Health care facility" has the same meaning as contained in the
regulations
promulgated
by the director of health pursuant to chapter 17 of this title.
(d) "Patient satisfaction" means the degree to which the facility or
provider meets or
exceeds
the patients' expectations as perceived by the patient by focusing on those
aspects of care
that the
patient can judge.
(e) "Quality of care" means the result or outcome of health care
efforts.
(f) "Risk-adjusted" means the use of statistically valid techniques
to account for patient
variables
that may include, but need not to be limited to, age, chronic disease history,
and
physiologic
data.
(g) "Performance measure" means a quantitative tool that provides an
indication of an
organization's
performance in relation to a specified process or outcome.
(h) "Reporting program" means an objective feedback mechanism
regarding individual
or
facility performance that can be used internally to support performance
improvement activities
and
externally to demonstrate accountability to the public and other purchasers,
payers, and
stakeholders.
(i) "Health care provider" means any physician, or other licensed
practitioners with
responsibility
for the care, treatment, and services rendered to a patient.
(j) "Insurer" means any entity subject to the insurance laws and
regulations of this state,
that
contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse
any of the
costs of
health care services, including, without limitation, an insurance company
offering
accident
and sickness insurance, a health maintenance organization, as defined by
section 27-41-
1, a
nonprofit hospital or medical service corporation, as defined by chapters 27-19
and 27-20, or
any
other entity providing a plan of health insurance or health benefits.
(k)
“Hospital-acquired infection” means a localized or systemic condition: (1) that
results
from
adverse reaction to the presence of an infectious agent(s) or its toxin(s); and
(2) may include
infections
not present or exhibiting signs and symptoms at the time of admission to the
hospital as
determined
by the department with recommendations from the health care quality steering
committee
with advice from the hospital acquired infections and prevention advisory
committee.
23-17.17-6.
Health care quality steering committee. -- (a) The director shall
establish
and
serve as chairperson of a health care quality steering committee of no more
than nineteen (19)
members
to advise in the following matters:
(1) Determination of the comparable performance measures to be reported on;
(2) Assessment of factors, including, but not limited to, factors related to
incidents and
events
reported to the department pursuant to section 23-17-40, contributing to the
provision of
quality
health care and patient safety;
(3) Selection of the patient satisfaction survey measures and instrument;
(4) Methods and format for data collection;
(5) Program expansion and quality improvement initiatives;
(6) Format for the public quality performance measurement report;
(7) Consideration of nursing-sensitive performance measures to be reported on;
(8) Consideration of the relationship between human resources and quality,
beginning
with
measurement and reporting for nursing staff;
(9) Consideration of measures associated with hospital-acquired infections with
consultation
of infections control experts; and with the hospital-acquired
infections and
prevention
advisory committee as established herein:
(i)
Hospital-acquired infections and prevention advisory committee:
(a)
The director of the department of health as the chairperson of the steering
committee
shall
appoint a permanent subcommittee called the hospital-acquired infections and
prevention
advisory
committee. Membership shall include representatives from public and private
hospitals,
infection
control professionals, director care nursing staff, physicians, epidemiologists
with
expertise
in hospital-acquired infections, academic researchers, consumer organizations,
health
insurers,
health maintenance organizations, organized labor, and purchasers of health
insurance,
such
as employers. The advisory committee shall have a majority of members
representing the
infection
control community.
(b)
The director of the department of health shall conduct a national and state
specific
public
reporting format scan of hospital acquired infection public reporting to be
completed and
transmitted
to the steering committee and referred to the advisory committee by October 1,
2008.
(c)
The advisory committee shall assist and advise the steering committee and the
department
in the development of all aspects of the department’s methodology for
collecting,
analyzing,
and disclosing the information collected under this act, including collection
methods,
formatting,
and methods and means for release and dissemination.
(d)
In developing the methodology for collecting and analyzing the hospital
infection
data,
the department, steering committee and advisory committee shall consider
existing
methodologies
and systems for data collection, such as the centers for disease control’s
national
healthcare
safety network, or its successor; provided, however, the department’s
discretion to
adopt
a methodology shall not be limited or restricted to any existing methodology or
system.
The
data collection and analysis methodology shall be disclosed with the public
report at the time
of
release.
(e)
The department, steering committee and the advisory committee shall evaluate,
on a
regular
basis, the quality and accuracy of hospital information reported under this act
and the data
collection,
analysis, and dissemination methodologies.
(ii)
Hospital reports:
(a)
Individual hospitals shall collect data on hospital-acquired infections for the
specific
clinical
procedures determined by the department by regulation, which may include the
following
general
categories as further defined by the advisory committee:
(I)
Surgical site infections;
(II)
Ventilator-associated pneumonia;
(III)
Central line-related bloodstream infections;
(IV)
Urinary tract infections;
(V)
Process of care measures, such as compliance with the surgical infection
prevention/surgical
care improvement program (SIP/SCIP) parameters, prevention bundles for
central
line-associated bloodstream infections, prevention bundles for
catheter-associated urinary
tract
infections, hand hygiene compliance, compliance with isolation precautions; and
(VI)
Other categories as recommended by the advisory committee.
(b)
Beginning on or before April 1, 2009, hospitals shall submit quarterly reports
on their
hospital-acquired
infection rates to the department. Quarterly reports shall be submitted, in a
format
set forth in regulations adopted by the department. Data in quarterly reports
must cover a
period
ending not earlier than one month prior to submission of the report. Annual
reports shall
be
made available to the public at each hospital and through the department. The
first annual
report
shall be due no later than October 2010.
(c)
The advisory committee shall recommend standardized criteria for reporting
surgical
site
infection outcome data for quality improvement recommendations. This will
include
standards
for post discharge surveillance. The information shall be included in
hospital’s quality
improvement
and safety plan to reduce surgical site infection.
(d)
If the hospital is a division or subsidiary of another entity that owns or
operates other
hospitals
or related organizations, the quarterly report shall be for the specific
division or
subsidiary
and not the other entity.
(iii)
Department reports:
(a)
The department shall annually submit to the legislature a report summarizing
the
hospital
quarterly reports and shall publish the annual report on its website. The first
annual
report
shall be submitted and published no later than December 2010. Following the
initial
report,
the department shall update the public information on a yearly basis after it
has been
reviewed
by the steering committee with advice from the hospital-acquired infections and
prevention
advisory committee.
(b)
All reports of outcome measures issued by the department may be risk-adjusted
using
NHSN methodology
or other nationally accepted methodology, to adjust for the differences
among
hospitals as reviewed and recommended by the hospital-acquired infections and
prevention
advisory committee.
(c)
The annual report shall compare hospital-acquired infection data as recommended
by
the
advisory committee, collected under subsection (9)(b), for each individual
hospital in the
state.
The department, in consultation with the advisory committee, shall make this
comparison
as
easy to comprehend as possible. The report shall also include an executive
summary, written
in
plain language that shall include, but not be limited to, a discussion of
findings, conclusions,
and
trends concerning the overall state of hospital-acquired infections in the
state, including a
comparison
to prior years. The report may include policy recommendations, as appropriate.
(d)
The department shall publicize the report and its availability as widely as
practical to
interested
parties, including, but not limited to, hospitals, providers, media
organizations, health
insurers,
health maintenance organizations, purchasers of health insurance, organized
labor,
consumer
or patient advocacy groups, and individual consumers. The annual report shall
be
made
available to any person upon request.
(e)
No hospital report of department disclosure may contain information identifying
a
patient,
employee, or licensed health care professional in connection with a specific
infection
incident.
(10) Other related issues as requested by the director.
(b) The members of the health care quality performance steering committee shall
include
one
member of the house of representatives, to be appointed by the speaker; one
member of the
senate,
to be appointed by the president of the senate; the director or director's
designee of the
department
of human services; the director or the director's designee of the department of
mental
health,
retardation, and hospitals; the director or the director's designee of the
department of
elderly
affairs; and thirteen (13) members to be appointed by the director of the
department of
health
to include persons representing Rhode Island licensed hospitals and other
licensed
facilities/providers,
the medical and nursing professions, the business community, organized
labor,
consumers, and health insurers and health plans and other parties committed to
health care
quality.
SECTION
2. This act shall take effect upon passage.
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LC01649/SUB A
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