title: Classification tree analysis of race-specific subgroups at risk for a central venous catheter-related bloodstream infection.
abstract: BACKGROUND
  Studies of racial disparities in patient safety events often do not use race-specific risk adjustment and do not account for reciprocal covariate interactions. These limitations were addressed by using classification tree analysis separately for black patients and white patients to identify characteristics that segment patients who have increased risks for a venous catheter-related bloodstream infection.
  
  
  METHODS
  A retrospective, cross-sectional analysis of 5,236,045 discharges from 103 Florida acute hospitals in 2005-2009 was conducted. Hospitals were rank ordered on the basis of the black/white Patient Safety Indicator (PSI) 7 rate ratio as follows: Group 1 (white rate higher), Group 2, (equivalent rates), Group 3, (black rate higher), and Group 4, (black rate highest). Predictor variables included 26 comorbidities (Elixhauser Comorbidity Index) and demographic characteristics. Four separate classification tree analyses were completed for each race/hospital group.
  
  
  RESULTS
  Individual characteristics and groups of characteristics associated with increased PSI 7 risk differed for black and white patients. The average age for both races was different across the hospital groups (p < .01). Weight loss was the strongest single delineator and common to both races. The black subgroups with the highest PSI 7 risk were Medicare beneficiaries who were either < or = 25.5 years without hypertension or < or = 39.5 years without hypertension but with an emergency or trauma admission. The white subgroup with the highest PSI 7 risk consisted of patients < or = 45.5 years who had congestive heart failure but did not have either hypertension or weight loss.
  
  
  CONCLUSIONS
  Identifying subgroups of patients at risk for a rare safety event such as PSI 7 should aid effective clinical decisions and efficient use of resources and help to guide patient safety interventions.
authors.forename: James
authors.initials: J
authors.lastname: Studnicki
authors.forename: Bola F
authors.initials: BF
authors.lastname: Ekezue
authors.forename: Maka
authors.initials: M
authors.lastname: Tsulukidze
authors.forename: Peggy
authors.initials: P
authors.lastname: Honoré
authors.forename: Ramal
authors.initials: R
authors.lastname: Moonesinghe
authors.forename: John
authors.initials: J
authors.lastname: Fisher
mesh_terms: D000367:Age Factors; D055499:Catheter-Related Infections / Q000208:ethnology*; D062905:Central Venous Catheters / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005431:Florida; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015431:Weight Loss