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Administrative Databases Provide Inaccurate Data for Surveillance of Long-Term Central Venous Catheter-Associated Infections

Published online by Cambridge University Press:  02 January 2015

Sharon B. Wright ,
W. Charles Huskins ,
Rachel S. Dokholyan ,
Donald A. Goldmann  and
Richard Platt
Sharon B. Wright*
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
W. Charles Huskins
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Rachel S. Dokholyan
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Duke Clinical Research Institute, Duke University, Durham, North Carolina
Donald A. Goldmann
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Division of Infectious Diseases, Children's Hospital, Boston, Massachusetts
Richard Platt
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Harvard Vanguard Medical Associates, and Harvard Medical School, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
*
Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 330 Brookline Avenue, Mailstop SL-435, Boston, MA 02215
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Abstract

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.

Design and Setting:

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.

Patients:

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).

Conclusion:

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 946 - 949
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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