264438 Calculating the Device-Associated Infection rate in intensive care units using claims data

Sunday, October 28, 2012

Wan-Ming Chen, PhD Student , Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
Raymond Kuo, PhD , Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan
Tsung-Hsien Yu, PhD Student , Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
Ming Chin Yang, PhD , Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
Yee-Chun Chen, MD , Center for Infection Control, National Taiwan University Hospital, Taipei City, Taiwan
Mei-Shu Lai, MD, PhD , Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City, Taiwan
Introduction: The monitoring of device-associated healthcare-associated infections (DA-HAIs) in intensive care units (ICUs) using claim data has received a great deal of attention from administrators , quality advocates, and health care providers searching for an efficient means to track infections in their institutions. This study aimed to use the inpatient data of the National Health Insurance (NHI) to evaluate the trend of HAIs and compare it with Taiwan Nosocomial Infection Surveillance System (TNIS).

Method: A retrospective analysis of the NHI's claims database in 2007-2009, consisting of 99% of Taiwan's population of 23 million, was used to calculate the DA-HAIs of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI). Only patients who were admitted to ICUs during the study period were included in this study. For each hospital, the infection rates were calculated as the number of infected patients, identified by infection-related diagnosis codes or procedure codes, divided by the total number of ICU patients within a year. The hospital-level infection results were then compared to the data voluntarily reported by hospitals to the TNIS.

Result: The hospital ICU's three-year average CLABSI was 29.3 % (257,983 admissions), VAP was 5.3 % (326,890 admissions) and CAUTI was 16.8 % (325,135 admissions) using the claims data. For each hospital, the intra-hospital DA-HAIs ratio between the claims data method and the TNIS data for the three infection events were consistent across years. But the magnitudes of these ratios differed across the level of the medical institution (medical center, regional hospital, district hospital).

Conclusion: The result shows that although there were differences between the infection rates calculated using claims data and the TNIS system, the claims data method can be used as an alternative source of data for evaluating the healthcare-associated infection trend or outbreak in the ICU of a hospital.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
1. Evaluate if claims data can be used as an alternative source of data for monitoring the healthcare-associated infections in ICU. 2. Compare claim-based hospital-level infections rates with the data voluntarily reported by hospitals to a national healthcare-associated infection surveillance system.

Keywords: Health Care Quality, National Health Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the research assistant who did the analysis for this study and also the author who prepared the draft. The submission of this abstract and acting as the presenter has been authorized by the principal inspector and all other co-authors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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