title: Discord among performance measures for central line-associated bloodstream infection.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA 92617, USA. TehraniD@uci.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Tehrani
authors.forename: Dana
authors.initials: D
authors.lastname: Russell
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brown
authors.forename: Kim
authors.initials: K
authors.lastname: Boynton-Delahanty
authors.forename: Kathleen
authors.initials: K
authors.lastname: Quan
authors.forename: Laurel
authors.initials: L
authors.lastname: Gibbs
authors.forename: Geri
authors.initials: G
authors.lastname: Braddock
authors.forename: Teresa
authors.initials: T
authors.lastname: Zaroda
authors.forename: Marsha
authors.initials: M
authors.lastname: Koopman
authors.forename: Deborah
authors.initials: D
authors.lastname: Thompson
authors.forename: Amy
authors.initials: A
authors.lastname: Nichols
authors.forename: Eric
authors.initials: E
authors.lastname: Cui
authors.forename: Catherine
authors.initials: C
authors.lastname: Liu
authors.forename: Stuart
authors.initials: S
authors.lastname: Cohen
authors.forename: Zachary
authors.initials: Z
authors.lastname: Rubin
authors.forename: David
authors.initials: D
authors.lastname: Pegues
authors.forename: Francesca
authors.initials: F
authors.lastname: Torriani
authors.forename: Rupak
authors.initials: R
authors.lastname: Datta
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000145:classification; D002140:California; D055499:Catheter-Related Infections / Q000145:classification*; D014487:Centers for Medicare and Medicaid Services, U.S.; D059019:Clinical Coding / Q000592:standards*; D003428:Cross Infection / Q000145:classification*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D037141:Mandatory Programs; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult