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.

     

=======

LC01649/SUB A

=======