A successful, voluntary, multicomponent statewide effort to reduce health care-associated infections.

Health care-associated infections (HAIs) increase morbidity, mortality, and hospital costs. Multiple organizations have worked independently to reduce HAIs. Regional collaborative efforts to reduce HAIs have been less common but may be particularly effective. The authors describe a statewide multicomponent approach implemented by the Iowa Healthcare Collaborative (IHC) to reduce HAIs. IHC's initiatives helped providers improve patient care by becoming engaged in specific projects, improving communication, sharing data, and implementing best practices. Other states could use this approach as a model to engage clinicians in patient safety initiatives and thereby accelerate the rate at which clinical care and health care outcomes are improved.

Voluntary reporting of employee influenza vaccination rates by acute care hospitals in Iowa: the impact of a four year provider-based statewide performance improvement project.

OBJECTIVE: In 2006 a voluntary, provider-based project was initiated to improve influenza vaccination rates among healthcare workers (HCWs) employed by acute care hospitals in Iowa. The statewide vaccination target was 95% by 2010. Data from the first four influenza seasons (2006-2007, 2007-2008, 2008-2009 and 2009-2010) are presented. METHODS: A website was used to submit and circulate hospital-specific influenza vaccination rates. Rates were fed back to participating hospitals from the outset and hospital-specific rates made publicly available for the last two influenza seasons. RESULTS: Hospital participation rates ranged from 86% in season 1 to 100% in the subsequent three seasons. Statewide median hospital employee vaccination rates trended upward from 73% in season 1 to 93% in season 4. By season 4, 35% of participating hospitals had reached or exceeded a 95% vaccination rate. In season 4 the mean employee vaccination rate of 19 hospitals reporting use of a mandatory vaccination policy was 96% vs. 87% in the 64 hospitals not using such policies. CONCLUSION: Over a 4 year period, while participating in a provider-based, voluntary project, acute care hospitals in Iowa reported significantly improved seasonal influenza vaccination rates among their employees.

Cost-of-illness studies in the United States: a systematic review of methodologies used for direct cost.

OBJECTIVES: We undertake a systematic review to examine the methods used by researchers in developing cost-of-illness (COI) studies. This review aims to categorize the approaches that the published literature uses in terms of perspective, scope, components of care analyzed in the literature, data sets, and valuation approaches used for direct cost. It draws conclusions regarding the adequacy of current COI research methods and makes recommendations on improving them. METHODS: The online bibliographic information service HealthSTAR (which incorporates MEDLINE) was used to search for COI studies in the research literature published during the period from 2000 to 2004. The search strategy used the term "cost of illness" as a MeSH (medical subject heading) term. RESULTS: The HealthSTAR literature search identified references to 650 articles. Review of abstracts resulted in the identification of 170 of these for a more detailed review. This process identified 52 articles that met all criteria of COI studies. We identified 218 components of care analyzed across the 52 articles. Private-insurance or employer-claims data sets comprised the largest source of utilization and cost information among the studies. CONCLUSION: Analyzing cost of illness presents useful opportunities for communicating with the public and policymakers on the relative importance of specific diseases and injuries. Our research, however, indicates that COI studies employ varied approaches and many articles have methodological limitations. Without well-accepted standards to guide researchers in their execution of these studies, policymakers and the general public must be wary of the methods used in their calculation and subsequent results.