Discord among performance measures for central line- associated bloodstream infection

David M. Tehrani, Dana Russell, Jennifer Brown, Kim Boynton-Delahanty, Kathleen Quan, Laurel Gibbs, Geri Braddock, Teresa Zaroda, Marsha Koopman, Deborah Thompson, Amy Nichols, Eric Cui, Catherine Liu, Stuart H Cohen, Zachary Rubin, David Pegues, Francesca Torriani, Rupak Datta, Susan S. Huang

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)176-183
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume34
Issue number2
DOIs
StatePublished - Feb 2013

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Infection
Delivery of Health Care
Safety
Insurance Claim Review
Centers for Disease Control and Prevention (U.S.)
Bacteremia
Value-Based Purchasing
Mandatory Reporting
Centers for Medicare and Medicaid Services (U.S.)
Documentation
Medical Records
Cohort Studies
Retrospective Studies
Physicians

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

Cite this

Tehrani, D. M., Russell, D., Brown, J., Boynton-Delahanty, K., Quan, K., Gibbs, L., ... Huang, S. S. (2013). Discord among performance measures for central line- associated bloodstream infection. Infection Control and Hospital Epidemiology, 34(2), 176-183. https://doi.org/10.1086/66909

Discord among performance measures for central line- associated bloodstream infection. / Tehrani, David M.; Russell, Dana; Brown, Jennifer; Boynton-Delahanty, Kim; Quan, Kathleen; Gibbs, Laurel; Braddock, Geri; Zaroda, Teresa; Koopman, Marsha; Thompson, Deborah; Nichols, Amy; Cui, Eric; Liu, Catherine; Cohen, Stuart H; Rubin, Zachary; Pegues, David; Torriani, Francesca; Datta, Rupak; Huang, Susan S.

In: Infection Control and Hospital Epidemiology, Vol. 34, No. 2, 02.2013, p. 176-183.

Research output: Contribution to journalArticle

Tehrani, DM, Russell, D, Brown, J, Boynton-Delahanty, K, Quan, K, Gibbs, L, Braddock, G, Zaroda, T, Koopman, M, Thompson, D, Nichols, A, Cui, E, Liu, C, Cohen, SH, Rubin, Z, Pegues, D, Torriani, F, Datta, R & Huang, SS 2013, 'Discord among performance measures for central line- associated bloodstream infection', Infection Control and Hospital Epidemiology, vol. 34, no. 2, pp. 176-183. https://doi.org/10.1086/66909
Tehrani, David M. ; Russell, Dana ; Brown, Jennifer ; Boynton-Delahanty, Kim ; Quan, Kathleen ; Gibbs, Laurel ; Braddock, Geri ; Zaroda, Teresa ; Koopman, Marsha ; Thompson, Deborah ; Nichols, Amy ; Cui, Eric ; Liu, Catherine ; Cohen, Stuart H ; Rubin, Zachary ; Pegues, David ; Torriani, Francesca ; Datta, Rupak ; Huang, Susan S. / Discord among performance measures for central line- associated bloodstream infection. In: Infection Control and Hospital Epidemiology. 2013 ; Vol. 34, No. 2. pp. 176-183.
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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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AU - Brown, Jennifer

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AU - Quan, Kathleen

AU - Gibbs, Laurel

AU - Braddock, Geri

AU - Zaroda, Teresa

AU - Koopman, Marsha

AU - Thompson, Deborah

AU - Nichols, Amy

AU - Cui, Eric

AU - Liu, Catherine

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N2 - 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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