Methods: Rates of CLABSI were obtained for 22 CA and 45 NY hospitals that reported on this outcome to the National Healthcare Safety Network (NHSN) in 2009. NHSN rates of CAUTI and VAP were also obtained for a subset of the CA (N=17 for CAUTI; N=18 for VAP) and NY (N=40 for CAUTI; N=38 for VAP) hospitals that reported on each of these outcomes in 2009. Billing infection rates were evaluated for the same hospitals based on ICD9 codes from the CA and NY State Inpatient Databases (SID). To compare billing data to NHSN data, both rates were expressed as the number of infections per 1,000 patient days and rate ratios and 95% CIs were estimated for CLABSI/CRBSI, CAUTI and VAP.
Results: CRBSI rates measured by ICD9 codes in SID were significantly lower than CLABSI rates reported to NHSN (Rate ratio = 0.23, 95% CI 0.20, 0.25). Similarly, rates of CAUTI (Rate ratio = 0.12, 95% CI 0.10, 0.14) and VAP (Rate ratio = 0.16, 95% CI 0.13, 0.19) were significantly lower using billing data vs. NHSN data.
Conclusion: Billing data are poorly sensitive for identifying “true” infection rates in hospitals. The impact of the CMS policy may be mitigated by the poor sensitivity of the metric chosen by CMS for non-payment.
C. Gay, None
M. S. Calderwood, None
G. Lee, None