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Discord among Performance Measures for Central Line—Associated Bloodstream Infection

Published online by Cambridge University Press:  02 January 2015

David M. Tehrani ,
Dana Russell ,
Jennifer Brown ,
Kim Boynton-Delahanty ,
Kathleen Quan ,
Laurel Gibbs ,
Geri Braddock ,
Teresa Zaroda ,
Marsha Koopman  and
Deborah Thompson
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David M. Tehrani*
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Dana Russell
Affiliation:
Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
Jennifer Brown
Affiliation:
Division of Infectious and Immunologic Diseases, University of California Davis Medical Center, Sacramento, California
Kim Boynton-Delahanty
Affiliation:
Division of Infectious Disease and Infection Prevention and Clinical Epidemiology Unit, University of California San Diego, San Diego, California
Kathleen Quan
Affiliation:
Epidemiology and Infection Prevention Program, University of California Irvine Health, Orange, California
Laurel Gibbs
Affiliation:
Department of Hospital Epidemiology and Infection Control, University of California San Francisco Medical Center, San Francisco, California
Geri Braddock
Affiliation:
Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
Teresa Zaroda
Affiliation:
Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
Marsha Koopman
Affiliation:
Division of Infectious and Immunologic Diseases, University of California Davis Medical Center, Sacramento, California
Deborah Thompson
Affiliation:
Epidemiology and Infection Prevention Program, University of California Irvine Health, Orange, California
Amy Nichols
Affiliation:
Department of Hospital Epidemiology and Infection Control, University of California San Francisco Medical Center, San Francisco, California
Eric Cui
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Catherine Liu
Affiliation:
Division of Infectious Diseases, University of California San Francisco, San Francisco, California
Stuart Cohen
Affiliation:
Division of Infectious and Immunologic Diseases, University of California Davis Medical Center, Sacramento, California
Zachary Rubin
Affiliation:
Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
David Pegues
Affiliation:
Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
Francesca Torriani
Affiliation:
Division of Infectious Disease and Infection Prevention and Clinical Epidemiology Unit, University of California San Diego, San Diego, California
Rupak Datta
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
*
University of California Irvine School of Medicine, Division of Infectious Diseases and Health Policy Research Institute, 100 Theory Drive, Suite 110, Irvine, CA 92617 (TehraniD@uci.edu)
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Abstract

Background.

Central line-associated bloodstream infection (CLABSI) is a national target for mandatory reporting and a Centers for Medicare and Medicaid Services target for value-based purchasing. Differences in chart review versus claims-based metrics used by national agencies and groups raise concerns about the validity of these measures.

Objective.

Evaluate consistency and reasons for discordance among chart review and claims-based CLABSI events.

Methods.

We conducted 2 multicenter retrospective cohort studies within 6 academic institutions. A total of 150 consecutive patients were identified with CLABSI on the basis of National Healthcare Safety Network (NHSN) criteria (NHSN cohort), and an additional 150 consecutive patients were identified with CLABSI on the basis of claims codes (claims cohort). Ail events had full-text medical record reviews and were identified as concordant or discordant with the other metric.

Results.

In the NHSN cohort, there were 152 CLABSIs among 150 patients, and 73.0% of these cases were discordant with claims data. Common reasons for the lack of associated claims codes included coding omission and lack of physician documentation of bacteremia cause. In the claims cohort, there were 150 CLABSIs among 150 patients, and 65.3% of these cases were discordant with NHSN criteria. Common reasons for the lack of NHSN reporting were identification of non-CLABSI with bacteremia meeting Centers for Disease Control and Prevention (CDC) criteria for an alternative infection source.

Conclusion.

Substantial discordance between NHSN and claims-based CLABSI indicators persists. Compared with standardized CDC chart review criteria, claims data often had both coding omissions and misclassification of non-CLABSI infections as CLABSI. Additionally, claims did not identify any additional CLABSIs for CDC reporting. NHSN criteria are a more consistent interhospital standard for CLABSI reporting.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 176 - 183
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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