Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality in the neonatal intensive care unit (NICU). Medicaid is the payer for nearly half the newborns in the United States, and as such can drive hospital quality improvement through financial incentives including not reimbursing hospitals for CLABSIs acquired in the hospital (as mandated by the 2010 Patient Protection and Affordable Care Act).
Researchers evaluated hospital administrative data to see if it accurately reflected occurrences of CLABSIs. They compared CLABSIs identified by diagnostic code with infection control data that used criteria from the Centers for Disease Control and Prevention and National Healthcare Safety Network CDC/NHSN (considered the gold standard). The authors searched patient charts for clinical phrases that commonly identify CLABSI.
Of the 2,920 NICU infants admitted to the University of Michigan Health System NICU (2008–2010), 52 were identified as having a CLASBI; 42 by infection control data, seven though administrative data, and three by both. Half of the medical records for infants with CLABSI described an infection as line- or catheter-associated. In the other half, clinicians documented CLABSI cases by the microorganism responsible or more generally as “late onset sepsis.”
The authors recommend that payment policies “rely upon more accurate data by mandating reporting to CDC/NHSN and requiring institutions to ensure that their administrative data match these data.”