Healthcare-Associated Infections (HAIs) – General Overview

What it is and why it’s important

The Healthcare-Associated Infections (HAI) measures are developed by Centers for Disease Control and Prevention (CDC) and collected through the National Healthcare Safety Network (NHSN). They provide information on infections that occur while the patient is in the hospital. These infections can be related to devices, such as central lines and urinary catheters, or spread from patient to patient after contact with an infected person or surface. Many Healthcare-Associated Infections can be prevented when the hospitals use CDC-recommended infection control steps.

For more information about the HAIs visit the CMS Hospital Compare website.

Healthcare-Associated Infections (HAIs) – Definitions

Central Line-Associated Bloodstream Infections (CLABSI)

A central line is a narrow tube inserted by a doctor into a large vein of a patient's neck or chest to give important medical treatment. When not put in correctly or kept clean, central lines can become an easy way for germs to enter the body and cause serious infections in the blood. These infections are called Central Line-Associated Bloodstream Infections (CLABSIs), and they can be deadly. CLABSIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).

Catheter-Associated Urinary Tract Infections (CAUTI)

A catheter is a drainage tube that is inserted by a doctor into a patient’s urinary bladder through the urethra and is left in place to collect urine while a patient is immobile or incontinent. When not put in correctly or kept clean, or if left in place for long periods of time, catheters can become an easy way for germs to enter the body and cause serious infections in the urinary tract. These infections are called Catheter-Associated Urinary Tract Infections (CAUTIs), and they can cause additional illness or be deadly. CAUTIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).

Clostridium difficile Infections (C. diff.)

Clostridium difficile (C. diff.) is a type of bacteria that causes inflammation of the colon. C. diff. infection can cause severe diarrhea, fever, appetite loss, nausea, and abdominal pain. Symptoms from C. diff. infections often take a few days to develop. Patients are tested for C. diff. infections if they show signs of illness while in the hospital. This measure compares the number of stool specimens that tested positive for C. diff. toxin four or more days after the patient entered the hospital to a national benchmark.

Methicillin-resistant Staphylococcus aureus (MRSA)

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. MRSA infections in the bloodstream can be acquired in hospital settings, and may cause severe or life-threatening symptoms. Symptoms from MRSA infections often take a few days to develop. Patients are tested for MRSA bloodstream infections if they show signs of illness while in the hospital. This measure compares the number of MRSA-positive blood specimens collected four or more days after the patient entered the hospital to a national benchmark.

Surgical Site Infections from colon surgery (SSI: Colon)

A surgical operative procedure is one that is performed on a patient in an operating room where a surgeon makes at least one incision through the skin or mucous membrane to give important medical treatment. When not conducted in a sterile environment and following sterile procedures, a surgical site can become an easy way for germs to enter the body and cause serious infections in a patient, which can affect the skin, tissues under the skin, organs, or implanted material. These infections are called Surgical Site Infections (SSIs), and they can be deadly. SSIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).

Surgical Site Infections from abdominal hysterectomy (SSI: Hysterectomy)

A surgical operative procedure is one that is performed on a patient in an operating room where a surgeon makes at least one incision through the skin or mucous membrane to give important medical treatment. When not conducted in a sterile environment and following sterile procedures, a surgical site can become an easy way for germs to enter the body and cause serious infections in a patient, which can affect the skin, tissues under the skin, organs, or implanted material. These infections are called Surgical Site Infections (SSIs), and they can be deadly. SSIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).

Hospital Consumer Assessment of healthcare Providers and Systems (HCAHPS)

The Hospital Consumer Assessment of Healthcare providers and Systems (HCAHPS) is a national survey that asks patients about their experiences during a recent hospital stay. The number rating represents responses to survey questions with 5 being the best score. For more HCAHPS information visit Hospital Compare website: https://www.medicare.gov/hospitalcompare/Data/Overview.html.

Sanctions and Final Orders

The legal actions are issued for the licensee of the facility/provider at the time the case was initiated. If a change of licensee has occurred, “owner since” represents the date the current licensee began. The Final Order displays the name of the appropriate licensee. For more Sanctions and Final Orders information visit: http://apps.ahca.myflorida.com/dm_web/(S(tdinrrvcj5es2muw4swm44kx))/Default.aspx#Final_Orders.

3M All Patient Refined Diagnosis Related Groups (APR DRGs)

APR DRGs are a system for classifying inpatient data based on reason for admission, severity of illness and risk of mortality. The APR DRGs describe classes of patients who are similar both clinically and in their use of hospital resources. APR DRGs feature four severity of illness levels and four risk of mortality levels: minor, moderate, major and extreme. Base APR DRGs and subclasses are assigned using an 18-step clinical logic process. The underlying clinical principle of APR DRGs is that the severity of illness or risk of mortality subclass of a patient is highly dependent on the patient’s underlying problem and that patients with high severity of illness or risk of mortality are usually characterized by multiple serious diseases or illnesses. For more details regarding the clinical logic for APR DRGs, please visit the 3M Health Information Systems website at: https://apps.3mhis.com/docs/Groupers/All_Patient_Refined_DRG/Methodology_overview_GRP041/grp041_aprdrg_meth_overview.pdf

3M Enhanced Ambulatory Patient Groups (EAPGs)

Enhanced Ambulatory Patient Groups (EAPGs) are a patient classification methodology that explains the amount and type of resources used in a wide range of ambulatory visits, not just hospital outpatient departments but also ambulatory surgical centers, physician offices, and other diagnostic and therapeutic clinics. The concept of an EAPG, as with an APR DRG for inpatient care, is to group services that are similar both clinically and in their use of resources by the provider. Unlike inpatient APR DRGs, where each inpatient stay is assigned to one and only one APR DRG, a single ambulatory visit often includes more than one EAPG. Because the unit of analysis is the visit, the EAPG logic organizes the various EAPGs to measure the resources used for that visit.

A visit is defined as all related services provided to one patient on one day as submitted by a hospital, ambulatory surgery center or clinic. If the provider submits one claim that covers multiple days – often called a span bill – then the EAPG logic can split the claim into multiple visits using the line level service dates. And if the provider submits multiple claims for the same day, it is important to remember that the EAPG logic processes one claim at a time.

The following link provides additional details regarding the clinical logic for the EAPG grouper:

https://apps.3mhis.com/docs/Groupers/Enhanced_Ambulatory_Patient_Grouping_EAPGS/methodology_overview/grp403_eapg_meth_overview.pdf

Risk Adjustment Using 3M APR DRGs and EAPGs

Because of their expertise, some hospitals treat more high-risk patients, and some patients arrive at hospitals sicker than others and often sicker patients are transferred to specialty hospitals. That makes comparing hospitals for patients with the same condition but different health status difficult. To address this, the data is risk adjusted to reflect the score the facility would have had if it had provided services to the average mix of sick, complicated patients. In simpler terms, risk adjustment is a method to take a complex set of data and put it into terms where you can compare “apples to apples” and allows a fair comparison of performance between hospitals. Inpatient discharge data is risk adjusted using 3M All Patient Refined-Diagnosis Related Groups (APR DRGs); ambulatory surgery data uses a3M Enhanced Ambulatory Patient Groups (EAPGs) for risk adjustment.

3M APR DRGs support risk adjustment based on expected values – which are the average value of the resource (e.g. charges) or outcome variable such as average length of stay, that would result if the hospital’s mix of discharges within the APR DRG and severity of illness level had been treated at the average value of the resource or outcome in a reference data set. The reference data used for the hospital reporting are State of Florida discharges. Each APR DRG and severity of illness level is assigned an expected value based on the observed value or average in the statewide data.

3M EAPGs also support the development of expected values to risk adjust outpatient procedures in hospital reporting. Under EAPGs, the expected values are based on outpatient ambulatory surgery visits and calculated at the EAPG/CPT-4 code level. The reference data set used for the hospital reporting are State of Florida ambulatory surgery visits.

Explanation of Results Pages

Hospital Performance Measures

Average Length of Stay

The average length of stay is the typical number of days a patient stayed in the hospital for a particular condition or procedure.  For a fair comparison between hospitals, the information has been risk adjusted (See Risk Adjustment ) to take into account that some hospitals take care of patients who are sicker and require more treatment or resources than the "average" patient. 

Why is "length of stay" important?

Average length of stay provides an idea of how long you might expect to stay in the hospital as determined by your attending physician.  The average length of stay might show the efficiency of care provided by a hospital.  Typically, a shorter average length of stay decreases the chance of getting an in-hospital infection or experiencing a complication, and can be an indicator of improved outcomes.  However, if a length of stay is too short, it could result in a readmission.  To learn the typical length of stay for a particular condition or procedure look at the average length of stay for the state as whole and compare it to the hospital you are considering.  Keep in mind that only large differences are significant, so do not be concerned with slight differences. 

Readmission Rate

Readmission rates are risk adjusted using 3M APR DRGs and severity of illness as defined by the 3M Potentially Preventable Readmissions (PPR) software. A PPR is a return hospitalization within a specified time interval that reasonable clinicians would agree was likely related to the initial hospital stay. Readmissions are determined potentially preventable under the premise that if excellent care was received during the first hospitalization and the best possible coordination with the outpatient setting were provided after discharge, the patient would not have been readmitted. A detailed overview of the 3M PPR grouper methodology is available at this link: https://multimedia.3m.com/mws/media/1684594O/3m-potentially-preventable-readmissions-methodology-overview.pdf

The Readmission Rate is based on the percentage of patients who were readmitted to the same hospital or another short term acute care hospital for the same or related condition within 15 days of the initial discharge. 

This rate is assigned to the hospital that first admitted the patient regardless of where the patient is readmitted. 

Since sicker patients are more likely to be readmitted, the readmission rate is adjusted for the severity of patients’ illness.¹  A rate that is “lower than expected” indicates the hospital had fewer readmissions compared to other hospitals with similar patients.  A rate that is “higher than expected” indicates the hospital had more readmissions compared to other hospitals with similar patients.

Why is this important? 

Readmissions are costly and may indicate an opportunity to improve quality of care.  Readmissions may reflect health care challenges such as:

• Poor coordination between the inpatient and outpatient healthcare team,
• The patient not being able to get the prescription drugs or treatment needed following hospitalization,
• The patient may have had an underlying health condition that was not treated,
• The patient may have developed a complication after discharge,
• Medical care following discharge may not have been adequate,
• The patient may not have had an adequate support system after discharge
• The patient may not have followed the doctor’s instructions following discharge.

Patients can reduce their chances of being readmitted by being engaged and informed about health care decisions.  For example:

When you are being discharged from the hospital…

• Ask your doctor to explain the treatment plan you will use at home and get a written copy.
• Inform your doctor of all the medications including prescriptions and over the counter medicines that you take at home; compare pre and post hospital medications to make sure there are no duplications, omissions or harmful side effects.
• Ask about potential side effects of each medication and what to do if a side effect occurs and make sure all is explained in terms you can understand.
• Schedule your follow-up doctor’s appointments before you leave the hospital and make sure you have a transportation plan.
• Get your doctor’s name and phone number for regular working hours and who to contact in case of an emergency after hours and over the weekend.
• Make sure that any new medications or post hospital therapies the hospital doctor prescribes is covered by your insurance plan. If you do not have insurance, work with hospital staff to find out about low cost or no cost ways of paying for your medications and doctor visits.
• Learn about your condition and ask what symptoms might signal a change in health and for which you should contact your doctor.
• Request printed information to help you manage your health and any symptoms
• Make sure your doctor or nurse has answered your most important questions; write down questions before the discharge planning session.

Additional information regarding discharge planning can be found at this link:

https://www.caregiver.org/hospital-discharge-planning-guide-families-and-caregivers

Total Hospitalizations

Total hospitalizations is the total number of patients treated at that hospital for a particular condition or procedure, or if one is not selected, then the total number of hospitalizations at the facility. 

Why is a hospital's "total hospitalizations" important?

While volume of hospitalizations is not a direct measure of quality of care, it is useful in seeing how much experience a hospital has for a given procedure or condition.  Generally, the higher the volume the better.  If you have a condition that is not very common or involves complex procedures, you should consider the volume of similar cases your hospital handles, or find a facility with more experience with treating your condition.

Ambulatory (Outpatient) Surgery Center Performance Measures

Total Visits

Total visits are the count of ambulatory (outpatient) procedures a facility performs within each procedure category, or if you do not choose a category then the total number at the facility.  This data includes all ages.

Why is an ambulatory surgery center's "total visits" important?

Total visits or volume is an indication of the experience a facility has with a condition or procedure. Generally, the higher the volume the better.  In addition, many ambulatory surgery centers specialize in a certain area which may explain their higher volume.

Physicians

Physician Volume

Why is physician volume important?

There is no consensus about the minimum procedure volume for the procedures listed. It is best to consider the surgical volume listed on this website as just one component of the information you should gather to make the best decision for your care. You should also consult with your primary care physician and your health insurance provider whenever choosing a surgeon or hospital. See Data Disclaimer.

IMPORTANT: The physician volume methodology varies from the Compare Hospitals facility level information thus the totals are not comparable.