Central Line-Associated Bloodstream Infection Rates by Chronic Condition Groups in Children.

Abstract

The Deficit Reduction Act of 2005 and the Affordable Care Act of 2010 mandated that Medicaid and Medicare adopt payment-reduction policies that document hospital-acquired conditions.1,2 Central line–associated blood stream infection (CLABSI) is one of the most prevalent, potentially preventable acquired conditions in hospitalized children.3–5 The epidemiology of CLABSIs in PICUs and successes in reducing CLABSIs have been well described.6–9 Although line days are a recognized way of measuring risk of CLABSIs, there is no method to identify line days in the hospital discharge administrative billing data used for public reporting. Insertions of central lines and the risk of CLABSI are likely to increase according to the complexity of underlying conditions. In the absence of documentation of line days in administrative data, stratification of patient populations by medical complexity could be a useful way to determine CLABSI risk. Currently there is no method in administrative data reports to measure the risk of CLABSI according to underlying conditions. Diagnostic-related groups methods may provide a severity index for an admission, but they may not identify the patient’s underlying conditions. Children’s hospitals care for children with many complex chronic conditions, a group that seems to be increasing more than any other category.10 We proposed to determine the rates of CLABSI in 3 similar children’s hospitals according to patient complexity groups by using the 3M Health Information Systems’ clinical risk groups (CRGs).11 CRGs have already been used and validated as a method to stratify patients into complex chronic condition groups in children’s hospitals and health plan administrative data.10,12 We explore whether such stratification can provide reportable rates of CLABSI that reflect populations at risk. We have divided our population into 2 age groups, <1 year and ≥1 year, because of a …