Data For Calendar Year Research Articles

Choice of needleless connector technology as a risk reduction strategy for catheter related bloodstream infection, mortality, and cost: A secondary data analysis.

To compare relative risk (RR) of central line-associated bloodstream infection (CLABSI) between hospitals using Clave needleless connector technologies (NCT) and comparator hospitals using non-Clave NCT. And, to estimate avoided CLABSIs, mortality, and cost savings. Needleless connectors, while protective against needlestick injury, have long been implicated as a potential risk for CLABSI. Significant RR reduction of CLABSI among the many NCT has not been clinically demonstrated. The U.S. Healthcare-Associated Infections database was accessed for CLABSI data for calendar year 2019 via the Centers for Medicare and Medicaid Services website. This dataset was merged with the Clave NCT manufacturer's 2019 database to identify hospitals purchasing Clave NCT (MicroClave™, NanoClave™, Clave Neutron™, Clave™, Microclave™ Clear) and non-Clave NCT comparator hospitals. Sub-analysis of Clave NCT hospitals included: (1) Clave NCT mixed-use and (2) Clave high-volume use hospitals. The standardized infection ratio (SIR) was generated to estimate CLABSI RR after adjusting for intern/resident-to-bed-ratio (IRB), care location, and hospital demographics. Using the RR, avoided CLABSIs, mortality, and cost savings were calculated. A total of 2987 eligible hospitals (1288 Clave NCT, 1699 non-Clave NCT) with 17,452,575 central line-days were evaluated. All three Clave NCT hospital groups showed a statistically significant reduction in RR compared to the non-Clave NCT hospitals. The RR in Clave NCT hospitals was 0.93, a 7% decrease in CLABSI risk (p = 0.02). In the Clave NCT subgroups, mixed-use hospitals RR was 0.93, a 7% reduction (p = 0.04), while the Clave NCT high-volume hospitals experienced a 19% reduction, RR 0.81 (p = 0.04). An estimated 563 CLABSIs and 84 related deaths were avoided with use of Clave NCT and $27,095,231 in cost savings. The use of the Clave NCT, in and of itself, is an effective risk reduction strategy for CLABSI prevention, reduced mortality, and substantial cost savings.

An Exploratory Analysis of the Association between Healthcare Associated Infections & Hospital Financial Performance.

Purpose: Healthcare-associated infections (HAIs) place a significant financial burden on United States hospitals. HAI treatments extend hospital lengths of stay and increase hospital operational costs while significantly reducing hospital profit margins. Given these challenges, the research aim of this study was to explore the association between HAIs and hospital financial performance. A better understanding of this relationship can assist hospital leaders in optimizing the use of scarce financial resources to reduce HAI prevalence. Methods: Data for calendar year 2022 for active short-term acute care hospitals (n = 1454) in the US were analyzed using multiple linear regression analysis. We explored two derived dependent variables, operating expense per staffed bed and operating expense per discharge. The independent variables included four healthcare-associated infection rates: methicillin-resistant Staphylococcus aureus (MRSA) infection rate, Clostridium difficile (C. diff) infection rate, Catheter-Associated Urinary Tract Infection (CAUTI) rate, and Central Line Associated Blood Stream Infections (CLABSI). Appropriate organizational and market-level variables that may independently influence hospital financial performance were included as control variables. Results: The results revealed that C. diff (β: 0.037, p < 0.05) and CAUTI (β: 0.031, p < 0.05) rates were positively associated with an increase in operating expense per staffed bed, while increases in MRSA (β: 0.042, p < 0.001), C. diff (β: 0.062, p < 0.001), and CAUTI rates (β: 0.039, p < 0.001) were correlated with increased operating expenses per discharge. Conclusions: This study demonstrates that specific HAIs may be associated with increased hospital expenses. Proactively targeting these infections through tailored interventions may lead to reduced hospital costs, improved financial performance, and economic stability.

Children and young people's body mass index measures derived from routine data sources: A national data linkage study in Wales.

Routine monitoring of Body Mass Index (BMI) in general practice, and via national surveillance programmes, is essential for the identification, prevention, and management of unhealthy childhood weight. We examined and compared the presence and representativeness of children and young people's (CYPs) BMI recorded in two routinely collected administrative datasets: general practice electronic health records (GP-BMI) and the Child Measurement Programme for Wales (CMP-BMI), which measures height and weight in 4-5-year-old school children. We also assessed the feasibility of combining GP-BMI and CMP-BMI data for longitudinal analyses. We accessed de-identified population-level GP-BMI data for calendar years 2011 to 2019 for 246,817 CYP, and CMP-BMI measures for 222,772 CYP, held within the Secure Anonymised Information Linkage Databank. We examined the proportion of CYP in Wales with at least one GP-BMI record, its distribution by child socio-demographic characteristics, and trends over time. We compared GP-BMI and CMP-BMI distributions. We quantified the proportion of children with a CMP-BMI measure and a follow-up GP-BMI recorded at an older age and explored the representativeness of these measures. We identified a GP-BMI record in 246,817 (41%) CYP, present in a higher proportion of females (54.2%), infants (20.7%) and adolescents. There was no difference in the deprivation profile of those with a GP-BMI measurement. 31,521 CYP with a CMP-BMI had at least one follow-up GP-BMI; those with a CMP-BMI considered underweight or very overweight were 87% and 70% more likely to have at least one follow-up GP-BMI record respectively compared to those with a healthy weight, as were males and CYP living in the most deprived areas of Wales. Records of childhood weight status extracted from general practice are not representative of the population and are biased with respect to weight status. Linkage of information from the national programme to GP records has the potential to enhance discussions around healthy weight at the point of care but does not provide a representative estimate of population level weight trajectories, essential to provide insights into factors determining a healthy weight gain across the early life course. A second CMP measurement is required in Wales.

Optimizing workflow of urgent stroke endovascular intervention: A focused lean six sigma project

IntroductionUrgent endovascular intervention is currently accepted as the primary and critical therapeutic approach to patients whose acute ischemic stroke results from a large arterial occlusion (LAO). In this context, one of the quality metrics most widely applied to the assessment of emergency systems performance is the “door-to-puncture” (D-P) time. We undertook a project to identify the subinterval of the D-P metric causing the most impact on workflow delays and created a narrowly focused project on improving such subinterval. MethodsUsing the DMAIC (i.e., define, measure, analyze, improve and control) approach, we retrospectively reviewed our quality stroke data for calendar year (CY) 2021 (i.e., baseline population), completed a statistical process control assessment, defined the various subintervals of the D-P interval, and completed a Pareto analysis of their duration and their proportional contribution to the D-P interval. We retooled our workflow based on these analyses and analyzed the data resulting from its implementation between May and December 2022 (i.e., outcome population). ResultsThe baseline population included 87 patients (44 men; mean age = 67.2 years). Their D-P process was uncontrolled, and times varied between 35-235 minutes (Mean = 97; SD = 38.40). Their door to angiography arrival (D-AA) subinterval was significantly slower than their arrival to puncture (AA-P) (73.4 v. 23.5 minutes; p < 0.01), accounted for 73% of the average length of the D-P interval. The group page activation to angiography arrival (GP-AA) subinterval accounted for 41.5% of the entire D-AA duration, making it the target of our project. The outcome population originally consisted of 38 patients (15 men; mean age = 70.3 years). Their D-P process was controlled, its times varying between 43-177 minutes (Mean = 85.8; SD = 34.46), but not significantly difference than the baseline population (p = 0.127). Their target subinterval GP-AA varied between 0-37 minutes and was significantly improved from the baseline population (Mean = 13.21 v. 29.68; p < 0.001). ConclusionsIt seems feasible and reasonable to analyze the subinterval components of complex quality metrics such as the D-P time and carry out more focused quality improvement projects. Care must be exercised when interpreting the impact on overall system performance, due to unexpected variations within interdependent subprocesses. The application of a robust and comprehensive LSS continuous quality improvement process in any CSC will have to include individualized focused projects that simultaneously control the different components of overall system performance.

Utilization and Staff Perspectives on an On-Demand Telemedicine Model for People with Intellectual and Developmental Disabilities Who Reside in Certified Group Residences.

Non-emergent medical problems that arise when a usual provider is unavailable can often result in emergency department or urgent care visits, which can be particularly distressing to people with intellectual and developmental disabilities (PIDD). On-demand, synchronous telemedicine may be a promising supplement when immediate care from usual sources is unavailable. Prior research demonstrated that high-quality telemedicine can be effectively delivered to PIDD. The aim of this article is to describe the utilization and staff perspectives on the implementation of the Telemedicine Triage Project (TTP), an innovative model that provides telemedicine consultations for PIDD who reside in state-certified group residences and present with an urgent but non-emergent medical concern when their usual provider is unavailable. Call frequency data for calendar years 2020 and 2021 were reviewed. The study team conducted semi-structured interviews, with 19 key informants representing organizational- and agency-level leadership and staff. The interview data were analyzed using a protocol-driven, rapid qualitative methodology. Telemedicine consultations increased from 7953 in 2020 to 15,011 calls in 2021, and call volume peaked between 10 am and 1 pm. Key informants reported high satisfaction with TTP; universal benefits and a few barriers to implementation; and strong interest in maintaining the program beyond the grant period. Over the first 2 years of its implementation, the TTP program was widely utilized and proved extremely feasible and acceptable to staff. This model is a promising and highly feasible way to provide equitable access to telemedicine for PIDD by addressing barriers to and disparities in access to health care that affect PIDD.

Development and validation of a standardized blood culture contamination definition and metric dashboard for a large health care system.

Blood culture contamination is a major problem in health care, with significant impacts on both patient safety and cost. Initiatives to reduce blood culture contamination require a reliable, consistent metric to track the success of interventions. The objective of our project was to establish a standardized definition of blood culture contamination suitable for use in a Veterans Health Administration (VHA) national data query, then to validate this definition and query. A secondary objective was to construct a national VHA data dashboard to display the data from this query that could be used in VHA quality improvement projects aimed at reducing blood culture contamination. A VHA microbiology expert work group was formed to generate a standardized definition and oversee the validation studies. The standardized definition was used to generate data for calendar year 2021 using a Structured Query Language data query. Twelve VHA hospital microbiology laboratories compared the data from the query against their own locally derived contamination data and recorded those data in a data collection worksheet that all sites used. Data were collated and presented to the work group. More than 50,000 blood culture accessions were in the validation data set, with more than 1,200 contamination events. The overall blood culture contamination rate for the 12 facilities participating was 2.56% with local definitions and data and 2.43% with the standardized definitions and data query. The main differences noted between the 2 data sets were deemed to be issues in local definitions. The query and definition were then converted into a national data dashboard that all VHA facilities can now access. A standardized definition for blood culture contamination and a national data query were validated for enterprise-wide VHA use. To our knowledge, this represents the first reported standardized, validated, and automated approach for calculating and tracking blood culture contamination. This tool will be key in quality initiatives aimed at reducing contamination events in VHA.

Decreasing incidence of dialysis in older patients in The Netherlands as compared with other European countries: an international perspective.

After decades of increasing dialysis incidence, we observed a decreasing trend in the Netherlands in the last decade. We compared this trend with trends in other European countries. Aggregated data for calendar years 2001-2019 from the Dutch registries of kidney replacement therapy patients and the European Renal Association Registry were used. Dialysis incidence in the Netherlands was compared with that in 11 other European countries/regions using three age groups: 20-64, 65-74, and ≥75 years, taking into account pre-emptive kidney transplantation (PKT) incidence. Time trends were assessed as annual percentage change (APC) with 95% confidence intervals (CI) using joinpoint regression analysis. Between 2001 and 2019 the Dutch dialysis incidence decreased slightly among patients aged 20-64 years (APC -0.9, 95% CI -1.4; -0.5). For patients 65-74 and ≥75 years old, a peak was seen in 2004 and 2009, respectively. Afterwards, the decrease was most marked in patients aged ≥75 years: APC -3.2 (-4.1; -2.3) versus APC -1.8 (-2.2; -1.3) for patients 65-74 years old. PKT incidence increased significantly during the study period but remained limited compared to the observed decrease in dialysis incidence, especially among older patients. Large differences in dialysis incidence were observed among European countries/regions. A decreasing dialysis incidence among older patients was also seen in Austria, Denmark, England/Wales, Finland, Scotland, and Sweden. The Dutch dialysis incidence decreased most profoundly among older patients. This was also observed in several other European countries/regions. Although PKT incidence increased, it can only explain a minor part of the decrease in dialysis incidence.

1780. Analysis of Appropriate Outpatient Prescriptions based on Diagnosis Codes, Tennessee, 2020

Abstract Background In the US, approximately 60% of antimicrobial prescriptions (Rx) are written in the outpatient setting, and roughly 30% of those are unnecessary. The Tennessee Department of Health (TDH) previously described outpatient antimicrobial use in 2016 and 2018. TDH acquired additional data from the IQVIA Longitudinal Prescription and Medical Claims datasets. We sought to link antimicrobial Rx to diagnosis claims from preceding outpatient office visits to measure appropriateness of statewide antimicrobial Rx. Methods IQVIA medical claims data and antimicrobial Rx data for calendar year 2020 were used in this study. A unique patient ID was used to track antimicrobial Rx over time. Prescriptions filled within 7 days after a patient’s medical visit were included. Diagnoses codes from the medical visits were categorized as Tier 1 (diagnoses that always require antimicrobial therapy) and Tier 3 (diagnoses that never require antimicrobial therapy). Tier 2 diagnoses were excluded. We compared Tier 1 prescriptions versus Tier 3 Rx volume. Results We identified 2.3 million Rx linked to a preceding outpatient office visit within 7 days; 70.5% were filled within 3 days of the corresponding office visit, 14.1% within 4–5 days, and 15.4% within 6–7 days. Of all included Rx, 16.4% were prescribed following a pure Tier 1 diagnosis, and 83.6% were prescribed following a pure Tier 3 diagnosis. Diagnoses for respiratory conditions accounted for 38.4% of the pure Tier 3 visits, urinary tract conditions for 17.7%, gastrointestinal conditions for 16.2%, and skin and soft tissue conditions for 15.8%. For the respiratory conditions, viral upper respiratory infection accounted for the highest percent of antimicrobials prescribed (27.1%), followed by asthma/allergy indications (17%), and bronchitis (8.9%). Conclusion A significant number of antimicrobials prescribed in Tennessee in 2020 were able to be linked to office visit diagnosis codes. Most Rx were prescribed for indications that do not require antimicrobial therapy. Respiratory conditions accounted for the highest percentage of visits resulting in antimicrobial therapy that did not require treatment. Continued educational efforts and provider feedback of these data are planned to combat unnecessary overprescribing in Tennessee. Disclosures Milner B. Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson &amp; Johnson: Stocks/Bonds.

Capture-recapture study to estimate the true incidence of tuberculosis in Portugal, 2018

Abstract Accurate estimation of the true number of cases of an infectious disease is essential to plan and efficiently allocate available resources. This study aims to improve the Portuguese surveillance system for tuberculosis (TB) by identifying gaps in TB epidemiological surveillance at the national level. We estimated annual TB incidence using a capture-recapture method to assess the sensitivity of national TB surveillance. Using probabilistic record linkage between two data sources, the National Epidemiological Surveillance System (SINAVE) and National Tuberculosis Program Surveillance System (SVIG-TB), we extracted TB diagnosed cases data for calendar year 2018. All reported TB cases were included, classified as confirmed, probable or possible. A two-source capture-recapture analysis using a log-linear model was performed to estimate the number of unobserved TB cases in Portugal and of the proportion identified by the current TB surveillance system. Between the two datasets, we found 896 TB cases (of a total of 2170 cases) that could not be matched (37.5% SINAVE only, 62.5% SVIG only). Based on the log-linear model, it was estimated that there were 148 unobserved TB cases (95% confidence interval 127.96 - 171.31). Therefore, the estimated true number of TB cases in 2018 is 2318, so current surveillance has a sensitivity of 93.6%. Based on these findings, the TB incidence in Portugal is estimated to be 22.55 cases per 100 000 inhabitants. Capture-recapture methods are useful in estimating annual TB incidence in high-resource settings. Although the two TB surveillance systems capture the majority of TB cases in Portugal, we might still be underestimating the true number of TB cases. Because TB is a high impact infectious disease, precise incidence estimates are crucial to allocate treatment and prevention resources and guide health policies. Key messages CRC method showed that Portugal is a TB low incidence country. Epidemiological surveillance systems should have a high sensitivity in order to allocate efficiently resources available.

DNR Orders Known at the Time of Admission Can Improve Hospital Mortality Ratings

Research ObjectiveThe Center for Medicare and Medicaid Services (CMS) publishes measures of risk‐adjusted hospital mortality rates that are meant to guide consumers and to contribute to Value‐Based Payment (VBP) quality ratings used to redistribute up to $2 billion in Medicare payments annually. A hospital’s actual to expected (A/E) mortality ratio accounts for 25% of its VPB rating. Current risk adjustment for mortality rates includes previously coded comorbidities and complications (CCs) but does not include indicators of higher mortality risk such as Do Not Resuscitate (DNR) orders present on admission (POA). We examined whether hospital mortality ratings could be improved by allowing DNR orders that are POA to identify a high‐risk group of patients among the 3 CMS mortality cohorts: acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN).Study DesignWe created a risk‐adjusted ranking of hospitals with and without admissions that had a DNR code POA using the All‐Patient Refined Diagnosis Risk Group Risk of Mortality (APR DRG RoM) at admission for the VBP cohorts. We computed the ratio of deaths to admissions for each DRG and ROM level for the 3 VBP cohorts as well as for all hospital admissions for the year. These ratios provided an expected rate of mortality for every admission through indirect rate standardization. For the 3 mortality rate cohorts, we calculated independent A/E mortality ratios for each hospital using existing CMS cohort definitions. We then repeated the calculation excluding admissions where DNR was reported as POA. We ranked the hospitals by A/E mortality rates and examined the change in decile ranks with and without DNR POA cases.Population StudiedWe used data for calendar year 2016 (CY2016) from the CMS Fee‐for‐Service (FFS) claims file for diagnosis codes and DNR status and used the Medicare Master Beneficiary Summary File (MBSF) to identify all deaths within 30 days of hospital admission. Among a total hospitalized population of 8.21 million with a death rate of 8.2%, there were 1.032 million admissions from the 3 VBP cohorts, of whom 14.2% had a DNR order POA and 11.3% died.Principal FindingsUnsurprisingly, the presence of a DNR order POA was associated with a much higher risk of 30‐day mortality. Overall, death rate for the mortality cohorts with DNR POA was 29.7%, compared to 8.2% without. For the entire hospitalized population, death rate was 30.3% with a DNR order POA, and 5.8% without. With the removal of DNR POA patients, hospital A/E mortality rankings changed substantially. 70% of hospitals moved up or down by at least one decile, and 34% moved up or down by 2 or more deciles.ConclusionsThe DNR POA order identifies patients at higher risk of death and can thereby alter VBP hospital mortality rate rankings and the resulting payment redistributions.Implications for Policy or PracticeIf the purpose of scrutinizing mortality rates is to identify preventable deaths, then continuing to include patients whose goals of care include DNR status can distort the risk‐adjustment process. The CMS mortality model should include adjustments for patients with DNR POA orders or remove them from the analysis entirely.

Emergency department encounters for opioid abuse, adverse events, poisoning, and dependence among members of a community-based health insurance plan\u2014Central Texas, 2016\u20132018

BackgroundThe United States appears to be in the midst of an opioid epidemic. National data indicate a rise in emergency department visits for opioid-related causes over the past decade. This data, while important in helping to explain the magnitude of the epidemic nationally offers only a glimpse of what can be expected to occur locally. The objective of this secondary data analysis was to describe the impact that opioid abuse, adverse events, poisoning, and dependence have on emergency department utilization for individuals who purchased health insurance under the Affordable Care Act in Central Texas from a community-based health maintenance organization.MethodsIndividuals who purchased health insurance from Sendero Health Plans in calendar years 2016, 2017, and 2018 were eligible for participation if they had both an emergency department encounter and an opioid-related ICD-10-CM diagnosis. Eligible individuals were assessed to determine if they were dispensed an opioid agonist or opioid antagonist prescription during the year of their emergency department encounter. Sendero medical claims data for calendar years 2016, 2017, and 2018 were used to calculate both the incidence and ratio of emergency department visits per 100,000-person Sendero member population. Sendero data were compared to available national data estimates.ResultsA total of 55 individuals had an emergency department encounter with a primary or secondary opioid-related diagnosis from January 1, 2016 through December 31, 2018. These 55 individuals had 69 unique emergency department encounters during this time period. The incidence of new claims per 100,000-member Sendero population was 67.1, 64.5, and 62.6 in 2016, 2017, and 2018 respectively. The ratio of unique emergency department encounters per 100,000-member Sendero population was 95.9, 82.6, and 66.5 in 2016, 2017, and 2018 respectively.ConclusionHealth insurance claims data from a community-based health plan can be used as a source of local information by policy makers and officials as they seek to address the impact of opioid abuse, adverse events, poisoning, and dependence in Central Texas as national data may not represent the local impact of this epidemic.

Unwarranted regional variation in vertebroplasty and kyphoplasty in Switzerland: A population-based small area variation analysis.

BackgroundPercutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) for treating painful osteoporotic vertebral fractures are controversial.ObjectiveWe assessed the regional variation in the use of VP/BKP in Switzerland.MethodsWe conducted a population-based small area variation analysis using patient discharge data for VP/BKP from all Swiss hospitals and Swiss census data for calendar years 2012/13. We derived hospital service areas (HSAs) by analyzing patient flows, assigning regions from which most residents were discharged to the same VP/BKP specific HSA. We calculated age-/sex-standardized mean VP/BKP-rates and measures of regional variation (extremal quotient [EQ], systematic component of variation [SCV]). We estimated the reduction in variation of VP/BKP rates using negative binomial regression, with adjustment for patient demographic and regional socioeconomic factors (socioeconomic status, urbanization, and language region). We considered the residual, unexplained variation most likely to be unwarranted.ResultsOverall, 4955 VP/BKPs were performed in Switzerland in 2012/13. The age-/sex-standardized mean VP/BKP rate was 4.6/10,000 persons and ranged from 1.0 to 10.1 across 26 HSAs. The EQ was 10.2 and the SCV 57.6, indicating a large variation across VP/BKP specific HSAs. After adjustment for demographic and socioeconomic factors, the total reduction in variance was 32.2% only, with the larger part of the variation remaining unexplained.ConclusionsWe found a 10-fold variation in VP/BKP rates across Swiss VP/BKP specific HSAs. As only one third of the variation was explained by differences in patient demographics and regional socioeconomic factors, VP/BKP in the highest-use areas may, at least partially, represent overtreatment.

Industry Payments in Cardiology: A Cross-sectional Analysis of Open Payments Data.

The goal of Open Payments and the Physician Payments Sunshine Act is to foster transparency and accountability to help stakeholders better understand financial ties between physicians and teaching hospitals and the pharmaceutical and medical device industries. To evaluate the nature of industry relationships among cardiologists using the Open Payments database. The authors used the Centers for Medicare & Medicaid Services Open Payments data for calendar year 2015 to evaluate the financial relationship between cardiologists and medical industries (manufacturers of medications, devices, biologics, and medical supplies). The database used in this specific investigation included general payments reported for 2015. Payments were broken down by totals, type, company, and range. In the 2015 calendar year, 81,977 payments were made to 12,078 cardiologists, amounting to $13,906,167.43. The minimum payment made to a cardiologist was $1.16 and the maximum, $2,805,825. The most frequent category was $11 to $50, with 53,722 payments made (65.5%), followed by less than $10, with 12,307 payments made (15.0%). Payments to cardiologists were highly variable. Additional studies regarding the effects of these payments may be warranted.

Occurrence of Salmonella in Ready-to-Eat Meat and Poultry Product Samples from U.S. Department of Agriculture–Regulated Producing Establishments. II. Salmonella in Ready-to-Eat Pork Barbecue Products, from 2005 to 2012

Ready-to-eat (RTE) meat and poultry product samples from the random ALLRTE and risk-based RTE001 sampling projects of the Food Safety and Inspection Service (FSIS) were tested for both Listeria monocytogenes and Salmonella. In the course of analyzing Salmonella data for calendar years 2005 to 2012, it was observed that 8 (17.0%) of 47 positive samples were from pork barbecue. The eight Salmonella-positive samples, from seven establishments in a single state, were from 1,085 pork barbecue samples tested nationwide (0.74% positive) and from 296 samples tested from that one state (2.7% positive). The seven establishments represented 30.4% of 23 federal establishments in that state that had pork barbecue samples tested for Salmonella. A follow-up sample from intensified verification testing at one of the seven establishments also was positive for Salmonella. Upon further examination, contamination appeared to be influenced by regional differences in production methods. Notably, the style of pork barbecue that tested positive for Salmonella used a vinegar- and pepper-based sauce in which the ingredients were mixed without cooking. All the establishments with Salmonella-positive samples followed the practice of first cooking the pork and then adding the barbecue sauce ingredients (vinegar, pepper, other spices, etc.) after cooking (postlethality exposure). In addition to the sauce ingredients, other possible sources of contamination included employee hygiene and food handling practices and cross-contamination from other Salmonella-contaminated products and from commonly used equipment. Based on these findings, the FSIS issued guidelines recommending changes in production methods that would minimize or eliminate pork barbecue as a potential source of foodborne Salmonella infections.

A novel risk classification system for 30-day mortality in children undergoing surgery.

A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012–2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner.

Can National Healthcare-Associated Infections (HAIs) Data Differentiate Hospitals in the United States?

OBJECTIVE To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. DESIGN Secondary analysis of publicly available HAI data for calendar year 2013. METHODS We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC). RESULTS Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy). CONCLUSIONS HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs. Infect Control Hosp Epidemiol 2017;38:1167-1171.

Cost/Benefit Analysis of Case Management Policies in a DUI Lab.

A study was previously conducted and published describing the magnitude of the under-reporting of drugs in driving under the influence (DUI) cases by using a blood drug screen (BDS) case management protocol and to determine whether not reporting those drugs would have a meaningful impact on the DUI cases. A follow-up study presented herein was conducted to generate a larger dataset for evaluation and to compare the results to the original study. For this follow-up study of 576 cases, the laboratory BDS protocol was modified so that a BDS was performed for all felony cases and all misdemeanor cases with a BAC < 0.15 g/dL, regardless of the officer's request. A cost analysis estimate was also conducted using purchasing and statistical data for calendar year 2014. It was estimated that on average a BDS had a materials cost 30 times greater than a BAC and required over six times as much analyst time. To perform a BDS on every case as has been recommended, the estimated analysis materials cost and analyst time were 218 and 193% of the old protocol, respectively. The results of this follow-up study futher support the insufficiency of presenting drug positivity as a justification for completing drug analysis on every DUI case. For the vast majority of cases with a BAC > 0.08 g/dL, the drugs detected are not significant for supporting a DUI and do not warrant the substantial increase in analysis cost and time required.

Emergency Medical Service in the US National Park Service: A Characterization and Two-Year Review, 2012–2013

Visitors to US National Park Service (NPS) units have a unique set of needs in terms of emergency medical care. The purpose of this review is to quantify and characterize emergency medical services (EMS) activities in the NPS to elaborate on its unique aspects, establish trends, and benchmark these data against a sample of national EMS data. The EMS data for calendar years 2012 and 2013 were queried from national NPS reports. The EMS responses totaled 40 calls per million visitors in 2012 and 34 calls per million visitors in 2013. Of those, 75% required a basic life support level of care. There were comparable incidences of transported EMS trauma calls (49%) and medical calls (51%). Of a total of 137 sudden cardiac arrest events, 65% of patients received defibrillation and 26% survived to hospital release. There were 262 total fatalities in 2012 and 238 in 2013, with traumatic fatalities occurring approximately twice as often as nontraumatic fatalities. Across the country, the NPS responded to a large number of EMS calls each year, but with a relatively low frequency, considering the large number of visitors. This is a challenging setting in which to provide consistent EMS care throughout various NPS administered areas. The typical NPS EMS response provided basic life support level care to visitors with traumatic injuries. The NPS caregivers must be prepared, however, to respond to a varied and diverse range of EMS calls.

IRS Issues ACA‐Mandated Report on Exempt and Other Hospitals

The IRS, on January 28, submitted to Congress a report on tax‐exempt, taxable, and government‐owned hospitals, as mandated by the Patient Protection and Affordable Care Act (§ 9007(e)(1)). This report, which is based on data for calendar year 2011, was made public on March 9.

Exposure to particulate matter and ozone of outdoor origin in Singapore

Estimates of population exposure to ambient air pollution traditionally rely on concentrations measured at central-site monitors as a surrogate for concentrations to which people are exposed. In this study of Singapore, we estimate population-averaged exposure concentrations for PM2.5, PM10, and O3 by applying a model and data that account for age and gender demographics, intraurban regional variability, and microenvironmental effects with age- and gender-stratified time-activity budgets. The study addresses exposure only to air pollutants of outdoor origin. Spatially averaged midpoint estimates of lifetime ambient exposure concentrations are 59%, 52%, and 47% of outdoor concentrations for PM2.5, PM10, and O3, respectively. Utilizing ambient data for calendar year 2007, we estimate that intraurban variability in ambient concentration results in lifetime-integrated exposure concentrations in the respective ranges of 10–14 μg m−3 for PM2.5, 14–18 μg m−3 for PM10, and 7.5–15 μg m−3 for O3. Uncertainty in estimates of the indoor proportion of outdoor pollutants, which are input to the model, results in greater variability than do intraurban differences in ambient concentrations, resulting in respective ranges of 6.6–15 μg m−3 for PM2.5, 8.1–21 μg m−3 for PM10 and 6.8–16 μg m−3 for O3. Estimates of time spent in naturally ventilated (NV) homes are in the range 10–13 h/d across the population and exposures in NV homes contribute 49%, 53%, and 56% of total exposure for PM2.5, PM10 and O3, of outdoor origin, respectively. Results illustrate the importance of accurately characterizing climate-specific indoor–outdoor pollutant relationships to better quantify human exposure to air pollutants.