Hospital-acquired catheter-associated urinary tract infection (CAUTI) is one of the first 6 conditions Medicare is targeting to reduce payment associated with hospital-acquired conditions under Congressional mandate. This study was to determine the positive predictive value (PPV) and sensitivity in identifying patients in Medicare claims who had urinary catheterization and who had hospital-acquired CAUTIs.
CAUTIs identified by ICD-9-CM codes in Medicare claims were compared with those revealed by medical record abstraction in random samples of Medicare discharges in 2005 to 2006. Hospital discharge abstracts (2005) from the states of New York and California were used to estimate the potential impact of a present-on-admission (POA) indicator on PPV.
ICD-9-CM procedure codes for urinary catheterization appeared in only 1.4% of Medicare claims for patients who had urinary catheters. As a proxy, claims with major surgery had a PPV of 75% and sensitivity of 48%, and claims with any surgical procedure had a PPV of 53% and sensitivity of 79% in identifying urinary catheterization. The PPV and sensitivity for identifying hospital-acquired CAUTIs varied, with the PPV at 30% and sensitivity at 65% in claims with major surgery. About 80% of the secondary diagnosis codes indicating UTIs were flagged as POA, suggesting that the addition of POA indicators in Medicare claims would increase PPV up to 86% and sensitivity up to 79% in identifying hospital-acquired CAUTIs.
The validity in identifying urinary catheter use and CAUTIs from Medicare claims is limited, but will be increased substantially upon addition of a POA indicator.
"As just one example, although no participant spoke about having seen clear evidence of gaming the system, failing to document postadmission infections (i.e., " down-coding " ) represents a serious threat to the CMS reimbursement system. If CMS were to focus greater attention on hospital compliance with documentation around billing codes, which have previously been shown to have poor sensitivity and positive predictive values (Meddings, Saint, & McMahon, 2010; Zhan et al., 2009), hospital efforts might shift toward improving documentation, rather than improving infection prevention practices. An alternative solution would be to better align financial penalties with data more closely tied to outcomes, such as the CDC's National Health Care Safety Network (NHSN). "
[Show abstract][Hide abstract] ABSTRACT: In 2008, the Centers for Medicare & Medicaid Services introduced a new policy to adjust payment to hospitals for health care-associated infections (HAIs) not present on admission. Interviews with 36 hospital infection preventionists across the United States explored the perspectives of these key stakeholders on the potential unintended consequences of the current policy. Responses were analyzed using an iterative coding process where themes were developed from the data. Participants' descriptions of unintended impacts of the policy centered around three themes. Results suggest the policy has focused more attention on targeted HAIs and has affected hospital staff; relatively fewer systems changes have ensued. Some consequences of the policy, such as infection preventionists having less time to devote to HAIs other than those in the policy or having less time to implement prevention activities, may have undesirable effects on HAI rates if hospitals do not recognize and react to potential time and resource gaps.
Medical Care Research and Review 08/2011; 69(1):45-61. DOI:10.1177/1077558711413606 · 2.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: This study was performed in order to evaluate the frequency of DI, the predictictive factors of DI and to list the related complications.Study design: Prospective non randomized, open study.Patients and methods: All patients intubated in the critical care unit during the five months of the study were included. The previous history and clinical setting of the patients, the conditions and the complications of intubation were collected. DI was defined when the procedure required more than two laryngoscopies.Results: The study included 80 patients. The rate of DI was 22,5%. The Mallampati score (p
Annales Françaises d Anesthésie et de Réanimation 12/2000; 19(10):719-724. DOI:10.1016/S0750-7658(00)00316-6 · 0.84 Impact Factor
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