Position statement opposing mandatory name reporting of HIV-seropositive individuals.
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Confidentiality↗
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Results for “Mandatory Reporting”
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Re: Mandatory physician reporting of drivers with cardiac disease: ethical and practical considerations.
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Automobile Driving↗
A national survey of state maternal and newborn drug testing and reporting policies.
The prevalence rate of drug use by pregnant women in the United States has been shown to range from 7.5 percent to 11 percent. Drug exposure in utero has been associated with deleterious effects on the fetus and newborn. Public health officials are currently confronted with difficult policy decisions with regard to testing and reporting of pregnant and post-partum women and the provision of appropriate services. The widespread lack of consistent policy on the State level has led to bias in testing and reporting procedures and to the inappropriate use of the legal system as a deterrent to drug use during pregnancy. A survey of the 50 States and the District of Columbia found that no State currently has enacted legislation regarding testing. Thirteen States have mandatory reporting policies for drug-exposed newborns. Eleven of these States require reporting to social service agencies, at least 3 States routinely report to criminal justice agencies, and 10 require that reports be filed as child abuse or neglect. Many States without mandatory reporting statutes indicate that reports are made to social service agencies at the discretion of the health care provider. During fiscal year 1990, only 22 States specifically allocated funds for programs that address perinatal substance use. In States with mandatory reporting policies, reports should be made only to social service agencies in conjunction with the provision of appropriate preventive, medical, and social services to the woman and her infant. Interagency coordination is necessary to standardize testing and reporting practices within States and to effectively allocate resources.
Female↗
Mandatory disease reporting by German laboratories: a survey of attitudes, practices and needs.
In 2000, the new German infectious disease control act replaced aggregate with individual case reporting. The process was facilitated by the simultaneous introduction of electronic data transfer within the public health system. Reporting laboratories have not been electronically connected to this network. A survey by means of a postal questionnaire was conducted in 2003 among 537 German medical microbiology laboratories to explore their reporting habits, preference for electronic reporting formats, and relevant software equipment. Almost 90% of the respondents indicated a reporting delay of no more than 24 hours and 45% were still manually filling in paper forms for reporting purposes. The introduction of electronic reporting formats was favoured by 74% of the laboratories although 33% were not using any microbiology-specific software and the remaining 67% listed 62 different products. Pilot projects with selected software manufacturers might help to pave the way for the implementation of a standardised electronic infectious disease reporting format in Germany.
Attitude of Health Personnel↗
Differences in the reporting of care-related patient injuries to existing reporting systems.
BACKGROUND: This study compared the number of care-related injuries reported to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) with the number reported to 15 mandatory-reporting states. METHODS: The primary outcome measure was the number of patient injuries reported to each in 1999. RESULTS: In all categories examined, the number of reports submitted by accredited hospitals to states equaled or exceeded the number reported to JCAHO. DISCUSSION: State-reporting systems identified a greater number of care-related injuries than did the JCAHO system. Although JCAHO received fewer reports from accredited hospitals, its process requires an analysis of the event and a prevention plan, and it disseminates the lessons learned from reported events. For adverse event reporting to improve patient safety, there must be assurances that lessons are learned from these events, preventive measures are taken, and information is shared so others may benefit without having to experience the same adverse event. CONCLUSION: This study represents an early attempt to understand the system characteristics that influence hospital reporting of care-related patient injuries. As reporting systems become more prevalent and standardized, the influence of factors such as legal protections, confidentiality, and technology on reporting should be better understood.
Health Care Surveys↗
Abuse among rural mentally ill.
Each American adult has the right to make individual decisions. These decisions include preferences in lifestyle, occupation, diet, housing, health-care treatment, and allocations of financial resources. The right to autonomous decision making is not limited to young or middle-aged adults, nor is it limited to those occasions during which the individual has the capacity to personally participate in the decisions (US Congress, 1987). The right also applies to elderly, incapacitated, mentally ill, or dependent adults. Because of this autonomy, no individual must suffer physical, psychological, or financial coercion. Based on these rights, all 50 states have enacted statutes to protect dependent adults and to authorize government intervention in cases of suspected adult abuse (Hunzeker, 1990). Iowa is one of the states that has enacted dependent adult abuse legislation, and in 1988, health-care practitioners in Iowa became mandatory reporters of adult abuse (Iowa Code, 1992). As mandatory reporters, all nurses who treat, counsel, examine, or attend dependent adults must observe the physical status and interpersonal relationships of their clients and significant others to identify potential conflict or injury. Categories of abuse recognized by the Iowa law include physical, sexual, and financial abuse, neglect by self, and neglect by another (Figure).
Aged↗
Reporting infections. Mandatory vs. voluntary debate heats up as states enact legislation.
As more states mandate the reporting of health care-acquired infections and CMS spearheads a voluntary reporting initiative, hospitals ask: Is a patchwork of state regulations better than a nationwide mandatory or voluntary system? And when does all of this lead to "analysis paralysis," hindering hospitals' performance-improvement efforts?
Advisory Committees↗
The California Cardiac Surgery and Intervention Project: evolution of a public reporting program.
Mandatory public reporting of cardiac surgery outcomes in California was instituted in 2003. To study the impact of the program, the outcomes of coronary artery bypass graft (CABG), valve, and percutaneous coronary intervention (PCI) procedures performed after January 1, 2003 were compared with previous years using the Patient Discharge Database (PDD) of the Office of Statewide Health Planning and Development. Risk-adjusted in-hospital mortality for CABG, CABG plus valve or aneurysm, and valve procedures decreased during 2003 and 2004 compared with 1998 through 2002, and PCI mortality remained unchanged. The average annual procedural volume per hospital decreased 25 per cent (232% +/- 205% to 173% +/- 157%) for CABG and 18 per cent (310% +/- 278% to 253% +/- 235%) for all cardiac surgeries, whereas PCI increased 12 per cent (433% +/- 277% to 492% +/- 356%). During 2003 and 2004, less than one-half of the 120 hospitals performed 200 or more cardiac surgeries per year, and only 25 performed 300 or more. Higher CABG mortality was observed primarily in low-volume programs, but the relationship of volume to risk-adjusted mortality was not significant for any surgical group or for PCI. Identification of outlier status was facilitated by use of 30-day posthospital outcomes (death or reoperation) in addition to in-hospital mortality. This study suggests that the introduction of a mandatory cardiac surgery reporting program in California was associated with improved outcomes.
Angioplasty, Balloon, Coronary↗
Fuller disclosure. NQF to consider mandatory performance reporting.
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Disclosure↗
Reporting elder abuse: a medical, legal, and ethical overview.
Elder abuse is a growing public health problem in the United States, with research suggesting that women may be at higher risk of abuse than men are. Laws on elder abuse have emerged over the recent decades, with nearly all states requiring mandatory reporting of suspected elder abuse cases. Physicians play key roles in helping their elder patients; they are often the only accessible individuals outside a frail elderly patient's family circle and are therefore in an ideal position to detect, manage, and prevent elder abuse. Unfortunately, they are not living up to their potential for reporting elder abuse. Physicians must confront and overcome barriers to detecting and reporting in order to provide appropriate care to elderly patients. This article defines elder abuse, outlines barriers to detecting and reporting elder abuse, provides an overview of the existing elder abuse laws, discusses the dilemmas surrounding mandatory reporting, and offers suggestions on how to manage cases of suspected abuse.
Aged↗
Domestic violence screening, policies, and procedures in Indian health service facilities.
BACKGROUND: Research shows that domestic violence against women in the United States is common, and the prevalence of domestic violence is high among Native American women. Victims of domestic violence can benefit from appropriate office intervention and referral. This study examined the effect of administrative and legal requirements on screening for domestic violence in Indian Health Service (IHS) hospitals and clinics. METHODS: A questionnaire was mailed using the total design method to all IHS hospitals and clinics regarding activities related to domestic violence: screening; policies and procedures; presence of committees; staff training; and state and tribal mandatory reporting requirements. RESULTS: The response rate was 65%. Eighty-eight (62%) of 142 facilities screen for domestic violence. A facility was more likely to screen if it had policies and procedures for domestic violence. Ninety-one (64%) of sites had policies and procedures for domestic violence. Less than one half these sites evaluated the use of these policies and procedures. Hospitals were more likely to have policies and procedures than clinics, as were sites administered by the IHS, rather than those administered by tribal contract. Fifty-eight (40.8%) facilities indicated 18 states have mandatory domestic violence reporting requirements. Thirty-three (23.2%) facilities indicated 31 different tribes mandate reporting of domestic violence. Forty-two (29.6%) facilities reported mandatory staff training in at least one topic related to domestic violence in the past year. CONCLUSIONS: Domestic violence policies and procedures promote screening for this important health care problem.
Domestic Violence↗
Maltreatment of children in The Netherlands: an update after ten years.
Governmental consultation and advice on child abuse and neglect in the Netherlands started in 1972 as a two-year experiment with four offices for "confidential doctors" in four major cities of the country. After these two experimental years, a governmental institute for prevention of child abuse and neglect was organized. Over the ensuing decade the number of offices increased to ten, covering the whole country. The State Department of Welfare, Public Health, and Environment collected data from the confidential doctors and their coworkers every year. This study compares the data of the first year 1974 with those of 1983 in order to detect changing patterns over a 10-year period. The major changes are as follows: a threefold increase in cases, an extraordinary increase in cases of emotional maltreatment, an increase in detection of child fatalities but decrease in severity of physical abuse. Sexual abuse was hardly recognized in 1974 but gradually was recognized more frequently during the study decade and accounted for an alarming 7.2% of detected cases of maltreatment in 1983. No change was found in the social conditions of the family and the identity of the perpetrators--primarily fathers and/or mothers. A decrease was noted in the percentage of married parents. The increased percentage of single parents was primarily represented by mothers alone. An increase in the numbers of victims residing at home and a decrease in the need for children's homes as a temporary or permanent residence is attributed to aftercare. The discrepancy between the results of this voluntary notification system in the Netherlands and the results of a mandatory reporting system as used in the U.S.A. is still very high. The hope is that the government will decide to make reporting of maltreatment mandatory for everyone.
Adolescent↗
Influence of physicians' attitudes on under-notifying infectious diseases: a longitudinal study.
OBJECTIVES: To identify practitioners' demographic and professional characteristics associated with reporting of mandatory-reporting diseases (MRDs), and to identify attitudes associated with MRD reporting. DESIGN: Longitudinal study. SETTING: Regional Health Service of Galicia (North-western Spain). SUBJECTS: Random sample of 600 physicians. MAIN OUTCOME MEASURES: A postal questionnaire was used to measure the physicians' beliefs, knowledge and attitudes regarding MRDs. Associations between the independent variables and outcomes (notification or non-notification of MRDs every week during 1998) were modelled using the Andersen-Gill proportional hazards model. RESULTS: The response rate was 60.1%. The following beliefs, knowledge and attitudes were statistically associated with a smaller probability of reporting any given MRD: (1) I would only notify an MRD after confirming diagnosis; (2) the MRD reporting system interferes with my daily clinical practice; (3) besides the legal requirements, I would have to report MRDs as a medical professional; and (4) only the reporting of relevant or severe MRDs is necessary. Under-reporting was not associated with specialization (general or paediatric) or the type of contract (fixed or temporary), but was associated with gender. CONCLUSIONS: Some physicians' beliefs, knowledge and attitudes regarding MRDs are associated with under-reporting. This suggests that modification of certain attitudes and knowledge in physicians could greatly reduce the under-reporting of MRDs.
Attitude of Health Personnel↗
Legal considerations in the child psychiatric emergency department.
Clinicians who practice in the child psychiatric emergency department have the complex task of evaluating the mental health or substance abuse needs of children, adolescents, and their families during times of crisis. Adding to this challenging clinical task are multiple legal considerations with which the clinician must be familiar. The precise impact of these legal issues varies from state to state. Some of these legal considerations are present at the start of the evaluation (consent for evaluation or treatment), during the evaluation (psychiatric hospitalization), and at the end of an evaluation (mandatory reporting of suspected child abuse and duty to warn or protect third parties from harm). Other issues (confidentiality and consent for release of information) are present at all stages of the evaluation and continue long after the evaluation has been completed. Clinicians who evaluate the psychiatric needs of children and adolescents are urged to review their local state laws relating to civil commitment, confidentiality, and mandatory reporting.
Adolescent↗
Surveillance systems for STIs in the European Union: facing a changing epidemiology.
OBJECTIVES: To characterise the nature, content, and performance characteristics of existing national STI surveillance systems in the European Union (EU) and Norway, to facilitate collection of comparable surveillance data. METHODS: Cross sectional survey using a structured questionnaire. RESULTS: Case reporting from clinicians and/or laboratories is the mainstay of EU surveillance systems for bacterial STIs. Coverage of case reporting varies from less than 10% to over 75%, and lack of and/or heterogeneity in case definitions affect the relative specificity and sensitivity of reporting systems. Considerable variations also exist in STI care sites; the populations who use these services; and in partner notification practices, STI screening practices, and STI laboratory diagnostic tests employed, affecting the representativeness of reported data and the sensitivity of surveillance systems for detecting the true number of STI cases. CONCLUSIONS: The heterogeneity of current surveillance systems complicates direct comparison of STI incidence rates across Europe. Introduction of standardised case definitions for reporting, and increased coverage of mandatory reporting systems where necessary, are needed. Definition of standardised minimum datasets and use of sentinel and enhanced surveillance systems to supplement universal case/laboratory notification data, could improve our understanding of the distribution and determinants of STIs across Europe, and aid in the design of effective public health responses. In the context of the changing epidemiology of STIs, systems for detection and monitoring of localised outbreaks of acute bacterial STIs (syphilis and antimicrobial resistant gonorrhoea), as well as prevalence monitoring systems for frequently asymptomatic STIs (chlamydial infection and viral STIs), are also necessary.
Cross-Sectional Studies↗
[Performing surface and room disinfection in the hospital].
At a Berlin university hospital the regulations governing area disinfection were rendered mandatory for disinfectors by a service ordinance. The primary consideration, besides general hygienic aims, concerned the possibility of transmitting infections in the hospital. Classification into four degrees of infection or contamination led to an almost uniform type of disinfection measures, dominated by "wipe" disinfection using concentrations recommended by the German Association for Hygiene and Microbiology (Deutsche Gesellschaft für Hygiene und Mikrobiologie = DGHM) (the four degrees of infection being: I: no nosocomial infectious diseases, II: nosocomial infectious diseases, III: diseases that can be transmitted and are subject to mandatory reporting, IV: highly contagious diseases that can be transmitted on airborne basis and are subject to mandatory reporting). Room disinfection via evaporation or smoke screen with formaldehyde is now performed only in conjunction with degree No. IV listed above. Area disinfection methods under dispute, such as routine room disinfection or as a prophylactic measure, were discontinued for medico-toxicological and environmental hygiene reasons. The considerations and discussions resulting from the concept of area disinfection resulted in abolishing inadequately indicated disinfection measures at the university hospital.
Air Microbiology↗
The practice of infection control and applied epidemiology: a historical perspective.
The United States health care system and patient populations have changed substantially over the past several decades. The practice of infection control also has evolved since the landmark Study on the Efficacy of Nosocomial Infection Control project, and infection control professionals (ICPs) must continue to develop the knowledge and skills necessary to practice infection prevention and control. Practice analyses of infection control conducted between 1982 and 2001 were analyzed to determine changes in practice. These data reflect a 145% increase in infection control activities over a 20-year period. However, resources for infection control and prevention have not kept pace with this increased activity. In addition, the current trend toward mandatory reporting of health care-associated infections (HAIs) among several states will add more tasks for ICPs with limited resources, at the risk of spending less time on prevention and control activities. In keeping with its philosophy of quality health care and responsible public reporting, the Association of Professionals in Infection Control and Epidemiology, Inc, continues to explore the issue of mandatory reporting of HAIs.
Cross Infection↗
Surveillance of listeriosis in Los Angeles County, 1985-1986. A first year's report.
After a large food-borne outbreak of listeriosis in Los Angeles County, California, in 1985, the California State Department of Health Services instituted mandatory reporting of Listeria monocytogenes by clinical laboratories. From September 1, 1985, through August 31, 1986, 94 cases of listeriosis were reported in Los Angeles County for an annual crude incidence rate of 12 cases per million persons. Of the 94 cases, 37 (39%) were in neonates and/or their mothers and 57 (61%) were nonperinatal. The overall case fatality rate was 31%, with a perinatal case fatality of 16% (6 fetal and 23 nonperinatal); this compares with an epidemic perinatal case fatality rate of 32%. No significant differences were observed in age-adjusted, race-specific incidence rates among nonperinatal cases or race-specific incidence rates among perinatal cases. All but 2 of the nonperinatal patients had a known predisposing risk factor for the development of listeriosis, the most common of which was a prior history of steroid therapy. A clustering of cases was not identified. No common food sources were apparent. Patients presenting as perinatal cases were more likely to have ingested Mexican-style cheese, ice cream, and yogurt than those presenting as nonperinatal cases. Improved case ascertainment through mandatory reporting and laboratory-based surveillance will establish meaningful baseline levels of listeriosis.
Adolescent↗