Title: Using Health Policy Levers to Improve Quality and Prevent Infection
Description: Preventing healthcare-associated infections (HAI) is a national priority. The Centers for Disease Control and Prevention estimates that one of every 25 hospitalized patients contract a HAI while receiving care. In 2009, the annual cost for HAIs in United States’ hospitals was estimated to be $40 billion, and there were 99,000 HAI-associated deaths. In nursing homes (NH), the situation is more dire; among the 4 million NH residents each year, there are 1-2.6 million serious infections and 1 out of every 3 NH residents is colonized with a multi-drug resistant organism. In addition to the frequent infections, over prescription of antibiotics in NH is significant, and frequently inappropriate. NH residents with HAIs are subjected to burdensome treatments and diagnostic procedures, leading to more complications in an already vulnerable population in which quality of life not life prolongation is often the treatment goal. Policy levers are actions designed to realize health objectives that can be taken by either public or private entities, and by individuals or groups.

Health policy levers are deployed at all levels including federal, state, regional, and local levels. Vaccinations, such as polio, are one of the great success stories of how policy levers can prevent infections. However, undermined and eroded policy levers can have negative public health consequences, such as seen with the 2018-2019 rash of measles outbreaks. There is much work left to be done improving quality related to infections across all care settings. For this dissertation, I utilized the three-paper format and conducted studies examining the effectiveness of health policy levers used to improve healthcare quality and prevent infections across care settings. These studies were: 1) a systematic review of the published evidence on state mandatory reporting of HAI in hospitals; 2) an environmental scan cataloging state supported initiatives in NH infection prevention, and; 3) a quantitative analysis on the effect of new federal NH regulations on NH quality and patient outcomes. In the systematic review, I found that mandatory reporting was associated with reduced central line associate bloodstream infection rates.

The environmental scan demonstrated that wide variation existed between states’ initiatives to support infection prevention in NH. In the quantitative analysis, I found that new federal regulations were significantly associated in improved NH quality in UTI rates and vaccination rates for influenza and pneumonia infections. Based on these results, clinical providers, administrators, policy makers and researchers can use health policy levers to reduce infections and improve quality.