Greenville Health System, Greenville, SC.
Am J Infect Control. 2013 Dec;41(12):1195-9. doi: 10.1016/j.ajic.2013.03.295. Epub 2013 Jun 13.
Health care-associated infections are a cause of significant morbidity and mortality in US hospitals. Recent changes have broadened the scope of health care-associated infections surveillance data to use in public reporting and of administrative data for determining Medicare reimbursement adjustments for hospital-acquired conditions.
Infection surveillance results for catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia were compared with infections identified by hospital administrative data. The sensitivity and specificity of administrative data were calculated, with surveillance data considered the gold standard.
The sensitivity of administrative data diagnosis codes for CAUTI, CLABSI, and ventilator-associated pneumonia were 0%, 21%, and 25%, respectively. The incorporation of additional diagnosis codes in definitions increased the sensitivity of administrative data somewhat with little decrease in specificity. Positive predictive values for definitions corresponding to Centers for Medicare and Medicaid services-defined hospital-acquired conditions were 0% for CAUTI and 41% for CLABSI.
Although infection surveillance methods and administrative data are widely used as tools to identify health care-associated infections, in our study administrative data failed to identify the same infections that were detected by surveillance. Hospitals, already incentivized by the use of performance measures to improve the quality of patient care, should also recognize the need for ongoing scrutiny of appropriate quality measures.
在美国医院，与医疗保健相关的感染是导致发病率和死亡率显著上升的一个原因。最近的变化扩大了与医疗保健相关的感染监测数据的范围，以便用于公共报告和行政数据，以确定医疗保险对医院获得性疾病的报销调整。
对导管相关尿路感染（CAUTI）、中心静脉相关血流感染（CLABSI）和呼吸机相关性肺炎的感染监测结果与医院行政数据确定的感染进行了比较。计算了行政数据的灵敏度和特异性，以监测数据为金标准。
行政数据诊断代码对 CAUTI、CLABSI 和呼吸机相关性肺炎的诊断灵敏度分别为 0%、21%和 25%。在定义中增加其他诊断代码在一定程度上提高了行政数据的灵敏度，而特异性略有下降。与医疗保险和医疗补助服务中心定义的医院获得性疾病相对应的定义的阳性预测值分别为 CAUTI 为 0%和 CLABSI 为 41%。
尽管感染监测方法和行政数据被广泛用作识别与医疗保健相关的感染的工具，但在我们的研究中，行政数据未能识别出与监测方法相同的感染。已经受到使用绩效措施来提高患者护理质量的激励的医院，也应该认识到需要对适当的质量措施进行持续审查。
