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The impact of measurement changes on evaluating hospital performance: The case of catheter-associated urinary tract infections

  • Heather E. Hsu (a1) (a2), Rui Wang (a2) (a3), Maximilian S. Jentzsch (a2) (a3), Kelly Horan (a2), Robert Jin (a2), Donald Goldmann (a4), Chanu Rhee (a2) (a5) and Grace M. Lee (a6)...

Abstract

Catheter-associated urinary tract infections in 592 hospitals immediately declined after federal value-based incentive program implementation, but this was fully attributable to a concurrent surveillance case definition revision. Post revision, more hospitals had favorable standardized infection ratios, likely leading to artificial inflation of their performance scores unrelated to changes in patient safety.

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Corresponding author

Author for correspondence: Heather Hsu, MD, MPH, Email: heather.hsu@bmc.org

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Senior authors of equal contribution.

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References

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1. Quality Improvement Group, Office of Clinical Standards & Quality, Centers for Medicare & Medicaid Services. Memorandum: reporting period and reliability of AHRQ, CMS 30-day and HAC quality measures—revised. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/HVBP_Measure_Reliability-.pdf. Published 2011. Accessed February 1, 2019.
2. HAI surveillance changes for 2015. NHSN e-news. 2014;9(3):411.
3. National Healthcare Safety Network. Paving the path forward: 2015 rebaseline. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/2015rebaseline/index.html. Published 2018. Updated January 23, 2018. Accessed May 30, 2018.
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5. Hsu, HE, Wang, R, Jentzsch, MS, et al. Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting. JAMA 2019;321:509511.
6. The Preventing Avoidable Infectious Complications by Adjusting Payment (PAICAP) Project website. https://www.paicap.org/index.html. Accessed February 1, 2019.
7. Dicks, KV, Baker, AW, Durkin, MJ, et al. The potential impact of excluding funguria from the surveillance definition of catheter-associated urinary tract infection. Infect Control Hosp Epidemiol 2015;36:467469.
8. Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 405, 412, 413, 414, 416, 486, 488, 489, and 495. Federal Register. 2017;82(155):38259.
9. Fakih, MG, Groves, C, Bufalino, A, Sturm, LK, Hendrich, AL. Definitional change in NHSN CAUTI was associated with an increase in CLABSI events: evaluation of a large health system. Infect Control Hosp Epidemiol 2017;38:685689.
10. Huber, K, Cycan, K. The impact of NHSN definition changes on the attribution of secondary bloodstream infections. Open Forum Infect Dis 2016;3 suppl 1.

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