Evaluating the impact of mandatory public reporting on participation and performance in a program to reduce central line-associated bloodstream infections: evidence from a national patient safety collaborative

Abstract

Background: It is not clear whether mandatory reporting influences the efforts and performance of hospitals to prevent hospital-acquired infections. This study examines whether mandatory reporting impacted participation and performance in reducing central line-associated bloodstream infections (CLABSIs) in a national patient safety collaborative.

Methods: We analyzed 1,046 adult intensive care units (ICUs) participating in the national On the CUSP: Stop BSI program. We used a difference-in-difference approach to compare changes in CLABSI rates in states with no public reporting mandate, recent mandates, and longer-standing mandates. Chi-square tests were used to examine the differences in the participation rate.

Results: States enacting a law requiring mandatory public reporting of CLABSI rates around the time of the national program had the highest hospital participation rates (approximately 50%). Compared with units in states with no reporting requirement, units in the states with voluntary reporting systems or with longer periods of mandatory reporting experience had higher CLABSI rates at baseline and greater reductions in CLABSI in the first 6 months. State groups with mandatory public reporting of CLABSI showed a trend toward greater reduction in CLABSI after 1 year of program implementation.

Conclusion: Mandatory reporting requirements may spark hospitals to turn to proven infection prevention interventions to improve CLABSI rates. Reporting requirements do not teach sites how to reduce rates. ICUs need both motivation and facilitation to reach consumer expectations for infection prevention.

Keywords: Central line–associated bloodstream infections; Comprehensive Unit-based Safety Program; Health policy; Hospital-acquired infections; Mandatory reporting; Nosocomial infection.