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Do Experts Understand Performance Measures? A Mixed-Methods Study of Infection Preventionists

Published online by Cambridge University Press:  05 December 2017

Sushant Govindan*
Affiliation:
Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
Beth Wallace
Affiliation:
Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
Theodore J. Iwashyna
Affiliation:
Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
Vineet Chopra
Affiliation:
Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Patient Safety Enhancement Program, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
*
Address correspondence to Sushant Govindan, MD, Taubman Center FL 3 Rm 3920, 1500 E Medical Center Dr, SPC 5360, Ann Arbor, MI 48109 (sushantg@med.umich.edu).

Abstract

OBJECTIVE

Central line-associated bloodstream infection (CLABSI) is associated with significant morbidity and mortality. Despite a nationwide decline in CLABSI rates, individual hospital success in preventing CLABSI is variable. Difficulty in interpreting and applying complex CLABSI metrics may explain this problem. Therefore, we assessed expert interpretation of CLABSI quality data. DESIGN. Cross-sectional survey PARTICIPANTS. Members of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) METHODS. We administered a 10-item test of CLABSI data comprehension. The primary outcome was percent correct of attempted questions pertaining to the CLABSI data. We also assessed expert perceptions of CLABSI reporting.

RESULTS

The response rate was 51% (n=67).Among experts, the average proportion of correct responses was 73% (95% confidence interval [CI], 69%–77%). Expert performance on unadjusted data was significantly better than risk-adjusted data (86% [95% CI, 81%–90%] vs 65% [95% CI, 60%–70%]; P<.001). Using a scale of 1 to 100 (0, never reliable; 100, always reliable), experts rated the reliability of CLABSI data as 61. Perceived reliability showed a significant inverse relationship with performance (r=–0.28; P=.03), and as interpretation of data improved, perceptions regarding reliability of those data decreased. Experts identified concerns regarding understanding and applying CLABSI definitions as barriers to care.

CONCLUSIONS

Significant variability in the interpretation of CLABSI data exists among experts. This finding is likely related to data complexity, particularly with respect to risk-adjusted data. Improvements appear necessary in data sharing and public policy efforts to account for this complexity.

Infect Control Hosp Epidemiol 2018;39:71–76

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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