Sabtu, 26 Februari 2011

Maryland report on hospital associated complications: Don't waste your time reading it

This week, NPR and the Washington Post ran stories on a new report on healthcare associated complications in Maryland. The report can be viewed here. Based on the results of the report, nine hospitals are required to pay penalties due to higher than average rates of complications. Eleven of the report's 49 indicators are infectious complications, such as infection related to central venous catheters. However, what is most important to know is that the source of the data for the report is administrative claims (ICD-9 codes which were developed for billing purposes). We've blogged before about how notoriously inaccurate these codes are for determining whether patients experienced healthcare associated infections. This is because case ascertainment is performed by abstractors with little medical training using case definitions that were not designed for surveillance purposes. Last year, Pennsylvania, the state with the most comprehensive mandatory reporting program for healthcare associated infections in the country, abandoned use of administrative claims data and required that all hospitals use CDC surveillance methodology. Particularly when hospitals are going to be punished by fines and bad publicity, valid methods must be used. I noted in the report that there were 431 cases of "moderate infectious," at a cost of over $6 million. What in the world is "moderate infectious"? I don't think you could find an infectious disease doctor anywhere who could tell you what that is because there is no such thing. Those of us who work in hospital epidemiology understand the need for public reporting because our society values transparency and accountability. We get it. But public reporting is a two-way street that requires a commitment on the part of public agencies to insure that the data generated are obtained via state-of-the-art methods and risk adjusted in order to produce the most valid reports for the public. In other words, it's about playing fairly.

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