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Discord among Performance Measures for Central Line–Associated Bloodstream Infection

David M. Tehrani BS, Dana Russell MPH, Jennifer Brown MD, Kim Boynton-Delahanty RN, Kathleen Quan RN, Laurel Gibbs CLS/MT(ASCP), Geri Braddock RN, Teresa Zaroda RN, Marsha Koopman RN, Deborah Thompson RN, Amy Nichols RN, Eric Cui BS, Catherine Liu MD, Stuart Cohen MD, Zachary Rubin MD, David Pegues MD, Francesca Torriani MD, Rupak Datta MPH, Susan S. Huang MD MPH and University of California Healthcare Epidemiology Collaborative
Infection Control and Hospital Epidemiology
Vol. 34, No. 2 (February 2013), pp. 176-183
DOI: 10.1086/669090
Stable URL: http://www.jstor.org/stable/10.1086/669090
Page Count: 8
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Discord among Performance Measures for Central Line–Associated Bloodstream Infection
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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). All 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.

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