Administrative databases provide inaccurate data for surveillance of long-term central venous catheter-associated infections.
BACKGROUND
Efficient methods are needed to monitor infections associated with long-term central venous catheters (CVCs) in both inpatient and outpatient settings. Automated medical records and claims data have been used for surveillance of these infections without evaluation of their accuracy or validity.


OBJECTIVE
To determine the feasibility of using electronic records to identify CVC placement and design a system for identifying CVC-associated infections.


METHODS
Retrospective cohort study at an HMO and two teaching hospitals in Boston, one adult (hospital A) and one pediatric (hospital B), between January 1991 and December 1997. Tunneled catheters, totally implanted catheters, and hemodialysis catheters were examined. Claims databases of both the HMO and the hospitals were searched for 10 CPT codes, 2 ICD-9 codes, and internal charge codes indicating CVC insertion. Lists were compared with each other and with medical records for correlation and accuracy.


METHODS
All members of the HMO who had a CVC inserted at one of the two hospitals during the study period.


RESULTS
There was wide variation in the CVC insertions identified in each database. Although ICD-9 codes at each hospital and CPT/ICD-9 combinations at the HMO found similar total numbers of CVCs, there was little overlap between the individuals identified (62% for hospital A with HMO and 4% for hospital B).


CONCLUSIONS
Claims data from different sources do not identify the same CVC insertion procedures. Current administrative databases are not ready to be used for electronic surveillance of CVC-associated complications without extensive modification and validation.
Wright
Sharon B
SB
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts, USA.
Huskins
W Charles
WC
Dokholyan
Rachel S
RS
Goldmann
Donald A
DA
Platt
Richard
R
D001900:Boston / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000382:microbiology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D006279:Health Maintenance Organizations; D006751:Hospital Information Systems; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007344:Insurance Claim Reporting; D016347:Medical Records Systems, Computerized; D040442:Public Health Informatics; D015203:Reproducibility of Results; D018571:Sentinel Surveillance