Public Reporting of Healthcare-Associated Infections: The Impact of Public Policy on Healthcare Organizations and Patient Outcomes

Healthcare-associated infections (HAIs) are a significant source of morbidity and mortality in U.S. hospitals. Policy makers have responded with a variety of state and federal policies to reduce infections by increasing the visibility and accountability of hospital performance. One policy initiative that has gained momentum is state-level legislative mandates requiring hospitals to report HAI-related performance data, which often includes public release of this data. These reporting mandates have produced mixed results, however, regarding their impact on healthcare organizational processes, patient outcomes or consumer decision-making. This dissertation comprises three papers that explore the relationship between HAI public reporting, organizational climate and HAI infection rates. The first paper presents a conceptual framework derived from an integrative review of the HAI reporting literature that proposes new pathways for testing these relationships. The second paper uses data from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined (P-NICER) survey, specifically the Leading a Culture of Quality for Infection Prevention (LCQ-IP) instrument, to examine differences in infection prevention organizational climate between hospitals in states with and without HAI reporting mandates. Bivariate and multivariate analysis revealed no statistically significant associations between key climate domains supporting infection prevention and state reporting mandates, despite finding noted associations with other hospital characteristics. The final paper uses National Healthcare Safety Network (NHSN) surveillance data, from the P-NICER survey, to conduct a quasi-experimental longitudinal analysis examining the impacts of reporting mandates on Clostridium difficile (C. difficile) infections in U.S. hospitals. Poisson regression models yielded no statistically significant differences in incidence rate ratios for C. difficile at varying time intervals before and after implementation of reporting mandates. Sensitivity analysis showed similar findings, with no differences in rates of infections over time between hospitals in reporting and non-reporting states. This dissertation provides a well-circumscribed analysis of varying organizational factors and patient outcomes thought to be impacted by mandatory HAI reporting. Findings are used to propose new directions for nursing research and public policy