Hospital safety reports past due

Officials debate reasons for three studies’ delays

By Judith Graham | Tribune staff reporter

Four years after Illinois passed two groundbreaking laws designed to shed light on hospital safety and performance, patients are still in the dark.

The Illinois Hospital Report Card — at the time, the nation’s first effort to document hospital-acquired infections — has not been published. Nor has the Illinois Consumer Guide to Health Care, a separate study of medical care at hospitals and surgery centers that was scheduled to come out two years ago.

A third project focused on serious medical snafus was set to start Jan. 1 but is nowhere near ready to launch. And, more than a year after its formation, the state’s new Division of Patient Safety has two employees and is only now getting around to hiring a full staff.

“It’s disappointing because Illinois was the leader, the model state that everyone was looking to,” said Lisa McGiffert, a health-care expert at Consumers Union. “But they’re not a model anymore.”

All the projects shared an overarching purpose: to put detailed information about health care in the public domain so patients could become better consumers of medical services.

The Hospital Report Card’s focus was on infection rates and the adequacy of hospitals’ nursing staffs. The Consumer Guide was to compare hospitals’ performance on 30 leading medical procedures that have wide variation in outcomes and costs.

The Adverse Events report would examine egregious hospital errors, such as surgery on the wrong side of a person’s brain, and the Patient Safety Division was supposed to coordinate these efforts and other initiatives to improve care.

State officials blame the extended project delays on problems with the original legislation, a lack of funding and staff, and a lengthy regulatory process, among other issues.

Both pieces of legislation had to be amended, a process that took more than a year, said David Carvalho, a deputy director at the Illinois Department of Public Health. The department, already financially stretched, didn’t get a substantial funding boost to analyze necessary data, he said. And multiple layers of review were required.

“I think we had unrealistic expectations” for what it would take to get the job done, said Dr. Eric Whitaker, former head of the department.

Critics fault leadership

Officials now predict the Hospital Report Card will be ready for public release by October, five years after the legislation was passed. The Consumer Guide, originally targeted for January 2006, is scheduled for publication this summer. There is no timetable yet for releasing the Adverse Events report.

Many health-care observers don’t accept officials’ explanations for why the studies are so long overdue. They fault Gov. Rod Blagojevich for not making the projects a priority and contend that bureaucratic inertia in the Public Health Department has obstructed progress.

“You have to ask, where is the leadership that was supposed to make this happen?” said Michael Millenson, a health-care consultant and consumer representative on the Chicago Patient Safety Forum.

“We thought we had a fighting chance to get this done because this is a governor who claims to be committed to improving health care,” said state Rep. Julie Hamos (D-Evanston), lead sponsor for the legislation that created the Consumer Guide. “But the commitment hasn’t been there.”

Hamos said she tried repeatedly to get officials to devote more attention to the projects, to no avail. She suggested the governor’s office was focused on expanding health insurance coverage and pouring resources into the Illinois Department of Healthcare and Family Services, not public health.

A spokeswoman for the governor said the projects were moving forward but acknowledged that the pace was slow.

The champion of the Hospital Report Card was then-state Sen. Barack Obama, who now talks about the concept on the presidential campaign trial and has since pushed similar legislation in the U.S. Senate. In a written statement, Obama emphasized the need for the work to get done.

“Patients have the right to information about the cost and quality of hospitals so they can make informed decisions about their health,” he said in the statement. “We need to be sure we are making these report cards a reality.”

Last week, the state missed its most recent deadline.

Under legislation passed in 2005, the state was to establish by Jan. 1 a system for reporting and reviewing so-called “adverse events” in hospitals — errors that should never happen, such as leaving a surgical sponge inside a patient’s abdomen. But rules to implement the legislation haven’t been drafted, and an advisory group has not been appointed, as called for in the bill.

Illinois hospitals stand ready to report the data and are waiting for the state to act.

“We are fully prepared,” said Dr. William Barron, vice president of quality and patient safety at Loyola University Health System. But “resources have to be allocated and time spent” on the project by the state for it to succeed, he said.

The Illinois Division of Patient Safety, created by the governor in July 2006 during his last campaign, was supposed to coordinate the effort, yet it has been slow to start up too.

While a news release at the time announced plans for “sweeping and comprehensive changes to cut down on errors and improve patient safety,” the division went unfunded and unstaffed for a full year until director Mary Driscoll was hired in September.

An October 2006 Patient Safety Summit in Chicago, which pulled together more than 140 experts, was supposed to provide guidance, but proceedings were never published and momentum dissipated.

“Lots of people were left pretty frustrated,” said Dr. Carrie Nelson, chairman-elect of the Chicago Patient Safety Forum.

Hospitals call for completion

In the administration’s defense, Carvalho outlined several problems that took more time to address than expected.

For instance, he said, the original Hospital Report Card Act called for tracking hospitals’ infection rates using a method that was being phased out by the Centers for Disease Control and Prevention. That required discussions with health-care leaders and a legislative fix that wasn’t ready until summer 2005. Critics counter that the fix didn’t have to take that long and the department could have moved ahead on other fronts in the meantime.

With the Consumer Guide, there was a battle over adding information from ambulatory surgery centers, Carvalho said. That project involved analyzing an enormous amount of data previously collected by the Illinois Health Care Cost Containment Council, which was disbanded in 2002. But the Public Health Department didn’t get enough extra resources or staff to do the job, he said.

People intimately familiar with the department say that’s not the whole story. They claim infighting and inertia at the agency also contributed to project delays, and they note several high-level staffers left during the process.

Even hospitals feel the process has dragged on too long.

“We support the right for consumers to have access to this information,” said Patricia Merryweather, senior vice president with the Illinois Hospital Association. “It would be
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