The financial and clinical costs associated with hospital-acquired infections are becoming an increasing concern for hospitals and payers alike. Studies show that each year, approximately 2 million patients admitted to U.S. hospitals acquire an infection while hospitalized, accounting for about half of all major hospital complications. The financial impact of the problem is significant — the 4 percent of patients who acquire an infection while hospitalized erode as much as 185 percent of hospitals' net inpatient operating profits.
In the state of New Jersey alone, patients with hospital-acquired infections require an average additional seven-and-a-half days of hospital treatment, and the average additional cost to treat a hospital-acquired infection (HAI) is approximately $12,500. The cost of treating HAIs exceeds the reimbursement provided by most payers resulting in a net loss for the hospital.
The reimbursement provided comes out of the pockets of healthcare payers and consumers. One study, across 13 hospitals, which compared the financial outcomes of similarly ill patients with and without an infection, found that while the hospitals lost a combined $56.6 million on patients with hospital infections, payers carried an additional burden of:
Medicare: $23.3 million
Medicaid: $33 million
Commercial: $50.9 million
In New Jersey and across the United States, the existing system for identifying hospital-acquired infections can be slow and resource consuming. Because there are thousands of patient-care processes occurring throughout the hospital every day with infection risks (surgery, drawing blood, cleaning equipment, etc.), and billions of data permutations, it is a daunting task for infection control professionals (ICPs) to focus prevention efforts where and when they are most needed. In most hospitals, infection surveillance is targeted to high-risk areas where the most dangerous infections tend to emerge, for example, the ICU. On a daily basis, ICPs review lab reports and cross check positive lab results and patient medical records to identify issues that may require investigation and further action. This system helps identify hospital-acquired infections but rarely helps to prevent future infections or address current outbreaks in a timely fashion. In short, the system is mainly outcomes focused and leaves ICPs little time to investigate processes that, when not performed correctly, may result in infections. This limited perspective fails to provide ICPs with the tools they need to "prevent " infections.
Recognizing the need for a system to support hospital infection control, Horizon Blue Cross Blue Shield of New Jersey established the New Jersey Infection Prevention Partnership, or NJIPP, with 11 hospitals across the state to reduce hospital-acquired infections.
Above all, we wanted to provide hospitals in the NJIPP with a solution that was actionable and could help avert further infections. The ideal solution would provide real-time data so clinicians could focus their efforts on those areas where they can have the largest impact. Most importantly, the system had to provide clinicians with the right information at the right time in order to impact patient care and outcomes. Horizon Blue Cross Blue Shield reviewed several available tools before choosing MedMined, a service provided by San Diego-based Cardinal Health, combining data mining technologies, clinical expert consultation, educational support, and clinical and financial outcomes measurement to reduce the incidence of hospital-acquired infections. MedMined's Data Mining Surveillance service has been adopted in more than 200 hospitals.
The service uses an artificial intelligence technology to monitor an entire hospital and its outpatient population for the incidence of infections — both community and hospital-acquired. The service alerts infection control staff to processes causing increased infection risk so improvements can be made to prevent future infections. Hospitals using this service also have electronic access to their infection-related clinical data in real time to facilitate reporting, charting and automated alerts.
At the center of the service is the Nosocomial Infection Marker, or NIM, an electronic marker for hospital-acquired infections. The NIM provides an electronic measurement of the incidence of hospital-acquired, or nosocomial, infections. The NIM uses algorithms to analyze existing patient clinical data to identify hospital-acquired infections and compute rates of infection. The NIM also provides a repeatable and efficient method for hospitals to track infections of all types and in all locations, as well as to meet mandatory reporting requirements.
Hackensack University Medical Center (HUMC) was selected to participate in the NJIPP pilot demonstration program and received access to the service in October 2005. Prior to using MedMined, our surveillance efforts focused mostly on the ICU and device-related infections. Utilizing the MedMined service, our ICPs are able to compare NIM rates across multiple units and in a wide array of categories, including wound site infections, urinary tract infections, respiratory infections, and many others. With this information, the ICP team can determine how various units are performing, help them to identify where problems are occurring, and provide them with actionable information to prevent future occurrences. The MedMined data gives us a means to prioritize efforts. ICPs now know where to focus their attention to have the greatest impact.