WebinarPublic Reporting of Central Line-Associated BloodStream Infection (CLABSI) Data on the Maryland     Hospital Perfor...
Webinar Agenda10:30 – 10:35 a.m.   Welcome and Introductions                     Pamela W. Barclay, Director, Center for H...
Public Reporting Process and             Timeline• Feedback Reports• Preview Reports• Hospital Guide Posting of CLABSI Dat...
Hospitals - Comparable Evaluation System -Healthcare-Associated Infection Information (SB            135) Effective July 1...
HAI Advisory Committee                   Partnership of Key Stakeholders          •   Association of Professionals in Infe...
Why are Central Line-Associated BloodStream Infections (CLABSIs) important?What is covered by the CLABSI reporting        ...
What is a Health Care -Associated Infection                                  (HAI)?• Infections that patients acquire duri...
Central Line-Associated Blood                               Stream Infections            What is a Central Line?Flexible t...
Why are CLABSIs so important?Impact• Central line-associated bloodstream infections are  often devastating infections• Att...
Maryland CLABSI Reporting               Requirements• Intensive Care Units   – 45 of 46 acute care hospitals   – 76 ICUs  ...
What Central Line-Associated Blood Stream Infection (CLABSI) data will be reported?           Catherine Passaretti, M.D., ...
Developing Displays for Public         Reporting           • Johns Hopkins Medicine               – Catherine Passaretti, ...
Hospital Performance Evaluation             Guide              • Healthcare-Associated                Infections          ...
Focus Group Composition   Consumer Focus Group                 Health Care Professional       (13 members)                ...
Evaluation of Reporting                                         DimensionsPartition                 Comparison           I...
Focus Group Feedback: Highlights• Consumer Feedback   – Most important to have overall hospital CLABSI rate   – Concern ab...
16
Confidence Intervals at 95%: a range of possible rates orratios within which there is a 95 % confidence that the truerate ...
Standardized Infection Ratio (SIR):What is the SIR, how is it calculated, and how is                  it interpreted?     ...
What is the Standardized                 Infection Ratio (SIR)?• SIR is a summary measure used to compare the central line...
How is the SIR calculated?Risk Group                                                   NHSN CLABSI Rates for 2006- Stratif...
How is the SIR interpreted?• Because we can never obtain a hospital’s true “population”  data (e.g., all patients for all ...
How is the SIR Interpreted? (continued)                                                              SIR = 1.00 (Reference...
Preparing for the Release                Jim ReiterSenior Vice President for Communications     Maryland Hospital Associat...
Webinar Participant Questions  *Please follow Operator instructions for    submitting a question. Thank you.*             ...
Adjournment and Evaluation                       Questions•   Your feedback on this session is very important to us.•   We...
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Maryland Hospital Performance Evaluation Guide CLABSI Webinar - Download now for free the presentation at: http://vsis.co/VSIFlibraries

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Webinar on Public Reporting of Central Line-Associated Blood Stream Infection (CLABSI) Data on the Maryland Hospital Performance Evaluation Guide

October 6, 2010

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Maryland Hospital Performance Evaluation Guide CLABSI Webinar - Download now for free the presentation at: http://vsis.co/VSIFlibraries

  1. 1. WebinarPublic Reporting of Central Line-Associated BloodStream Infection (CLABSI) Data on the Maryland Hospital Performance Evaluation Guide October 6, 2010
  2. 2. Webinar Agenda10:30 – 10:35 a.m. Welcome and Introductions Pamela W. Barclay, Director, Center for Hospital Services, MHCC Beverly Miller, Senior Vice President, Professional Activities, MHA10:35 – 10:40 a.m. Review of Public Reporting Timeline Pamela W. Barclay, Director, Center for Hospital Services, MHCC10:40 – 10:50 a.m. Why are Central Line-Associated Blood Stream Infections (CLABSIs) important? What is covered by CLABSI reporting requirements? Lynne V. Karanfil, RN, MA, CIC, Corporate Coordinator Infection Prevention, MedStar Health-Corporate Quality and Safety Member, HAI Advisory Committee10:50 – 11:15 a.m. What Central Line-Associated Blood Stream Infection (CLABSI) data will be reported? Catherine Passaretti, M.D., Assistant Professor/Hospital Epidemiologist, Johns Hopkins Bayview Hospital Dr. Yair G. Rajwan, DSc, MSc, EE, PFNLM, Postdoctoral Fellow Division of Health Sciences Informatics, JHU School of Medicine11:15 – 11:25 a.m. Standardized Infection Ratio (SIR): What is the SIR, how is it calculated, and how is it interpreted? Anthony Harris, M.D., MPH, Professor, Epidemiology and Public Health University of Maryland School of Medicine, Member, HAI Advisory Committee11:25 – 11:35 a.m. Preparing for the Release Jim Reiter, Senior Vice President for Communications, MHA11:35 – 11:55 a.m. Webinar Participant Questions11:55 – 12:00 Noon Adjournment and Evaluation Questions 1
  3. 3. Public Reporting Process and Timeline• Feedback Reports• Preview Reports• Hospital Guide Posting of CLABSI Data• Update Schedule 2
  4. 4. Hospitals - Comparable Evaluation System -Healthcare-Associated Infection Information (SB 135) Effective July 1, 2006 • Requires the Commission to include HAI information in its Hospital Performance Evaluation Guide • Requires the system for reporting data to adhere to recommendations of: – Centers for Disease Control and Prevention (CDC) – CDC Healthcare Infection Control Practices Advisory Committee • Focus on Acute Care Hospitals – 46 Hospitals • Implementation Plan developed by Technical Advisory Committee 3
  5. 5. HAI Advisory Committee Partnership of Key Stakeholders • Association of Professionals in Infection Control (APIC)-Baltimore Chapter • CareFirst BlueCross BlueShield • Department of Health and Mental Hygiene – Infectious Disease and Environmental Health Administration – Information Resources Management Administration – Office of Health Care Quality • Delmarva Foundation for Medical Care • Health Care Consumers • Health Facilities Association of Maryland/Mid- Atlantic LifeSpan • Maryland Association of Ambulatory Surgery Centers • Maryland Hospital Association • Maryland Patient Safety Center • Society for Healthcare Epidemiology of America (SHEA) 4
  6. 6. Why are Central Line-Associated BloodStream Infections (CLABSIs) important?What is covered by the CLABSI reporting requirement? Lynne V. Karanfil, RN, MA, CICCorporate Coordinator Infection Prevention,MedStar Health-Corporate Quality and Safety Member, HAI Advisory Committee 5
  7. 7. What is a Health Care -Associated Infection (HAI)?• Infections that patients acquire during the process of care in a hospital or other healthcare facility which were not present on admission• Accounts for approximately 99,000 deaths in the United States each year and $28 to $33 billion dollars in excess health care costs.• Four categories of infections account for approximately three-quarters of HAI in the acute care hospital setting. These four categories are: (1) Surgical site infections; (2) Central line-associated bloodstream infections; (3) Ventilator-associated pneumonia, and; (4) Catheter-associated urinary tract infections.• In addition, infections associated with Clostridium difficile and MRSA also contribute significantly to the overall problem. Source: U.S. Department of Health and Human Services, Action Plan to Prevent Healthcare-Associated Infections, Executive Summary, p. 1. 6
  8. 8. Central Line-Associated Blood Stream Infections What is a Central Line?Flexible tubes placed by a needle into a large veinusually in the neck or upper chest that allow healthcare workers to administer treatment (i.e. ,chemotherapy, IV antibiotics, IV nutritional fluidsor dialysis). What is a Central Line-Associated Bloodstream Infection (CLABSI)?Laboratory-confirmed primary bloodstreaminfections that are not secondary to anotherinfection and that occur in Intensive Care Unit(ICU) or Neonatal Intensive Care Unit (NICU)patients in whom a central line or umbilicalcatheter was in place at the time of theinfection. 7
  9. 9. Why are CLABSIs so important?Impact• Central line-associated bloodstream infections are often devastating infections• Attributable mortality is estimated anywhere from 12- 35%• Extend ICU LOS by 5 days and hospital stay by 5-16 days for each infection• Estimated attributable costs ranging from $12k-30K per episode Source: Healthcare-Associated Infections Technical Advisory Committee, Developing a System for Collecting and Publicly Reporting Data on HAIs in Maryland, 2008.
  10. 10. Maryland CLABSI Reporting Requirements• Intensive Care Units – 45 of 46 acute care hospitals – 76 ICUs – 1,126 beds• Neonatal Intensive Care Units – Level III-13 Hospitals – Level II/III – 2 Hospitals – 430 bassinets 9
  11. 11. What Central Line-Associated Blood Stream Infection (CLABSI) data will be reported? Catherine Passaretti, M.D., Assistant Professor/Hospital Epidemiologist, Johns Hopkins Bayview Hospital Dr. Yair G. Rajwan, DSc, MSc, EE, PFNLM, Postdoctoral Fellow Division of Health Sciences Informatics JHU School of Medicine 10
  12. 12. Developing Displays for Public Reporting • Johns Hopkins Medicine – Catherine Passaretti, M.D., Yair G. Rajwan, Dsc, I-Fong Sun – Conducted Literature review – Reviewed HAI public reporting in other States – Developed alternate displays and evaluation tool • Focus Groups – Obtained feedback from health care consumers and health care professionals on what information is important and useful to report on CLABSIs 11
  13. 13. Hospital Performance Evaluation Guide • Healthcare-Associated Infections • Hospital/Patient Guide – Consumer View • Hospital Leader Guide – Health Care Professional View 12
  14. 14. Focus Group Composition Consumer Focus Group Health Care Professional (13 members) Focus Group (7 members)• Individuals with Personal • Patient Safety Officer (1) Experiences with HAIs (5) • Vice President, Quality and• Individuals with No HAI Personal Patient Safety (1) Experience (2) • Hospital Chief Medical Officer (1)• Former Newspaper Health • Surgical Intensive Care Unit Reporter (1) Nurse (1)• MHCC Commissioner (1) • Hospital CEO (1)• IT Specialist (1) • Health Department M.D./• Health Care Safety Consultant (1) Hospital Epidemiologist (1)• Senior Advocacy Representative • Cardiac Anesthesiologist (1) (1)• Quality/Patient Safety Expert with HAI Experience (1) 13
  15. 15. Evaluation of Reporting DimensionsPartition Comparison Interpretation Visualization Publication Star • Filled in significant better – Lower rate , half filled noAggregate Hospital data NHSN (National) difference – similar rate, not Comparative Table Annually filled – significant worse – Higher rate Colors • Green if lower, Yellow no diff, Red if higher Specific ICU data State Analysis Table Semiannually Shapes • Circle – Better then expected, Triangle – About the same as expected, Diamond – Worse Box Plot Quarterly/Monthly then expected Heat Map 14
  16. 16. Focus Group Feedback: Highlights• Consumer Feedback – Most important to have overall hospital CLABSI rate – Concern about confidence intervals and how to interpret small numbers of events – Need for “Pop-Up” boxes with clear definitions of terminology – Do not use the term “expected” –health care infections should not be expected! – Need to update regularly• Health Care Professional Feedback – Focus on overall performance and meaningful level of aggregation beneath overall total – Report number of infections and central line days – Provide SIR confidence intervals at 95% with explanation of how to interpret – Need to update regularly and show changes in performance over time 15
  17. 17. 16
  18. 18. Confidence Intervals at 95%: a range of possible rates orratios within which there is a 95 % confidence that the truerate or ratio lies given the number of infections and centralline days. 17
  19. 19. Standardized Infection Ratio (SIR):What is the SIR, how is it calculated, and how is it interpreted? Anthony Harris, M.D., MPH Professor, Epidemiology and Public Health University of Maryland School of Medicine Member, HAI Advisory Committee 18
  20. 20. What is the Standardized Infection Ratio (SIR)?• SIR is a summary measure used to compare the central line- associated blood stream infections (CLABSIs) experience among hospitals or a group of locations to that of a standard population’s experience.• The standard population (used to calculate the predicted number of infections) comes from NHSN data reported from all hospitals for the period 2006-2008. – National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009 (Published American Journal of Infection Control 2009; 37:783-805)• Indirect standardization method.• Accounts for differences in risk of HAI among the groups. 19
  21. 21. How is the SIR calculated?Risk Group NHSN CLABSI Rates for 2006- Stratifier Observed CLABSI Rates (2009) 2008 (Standard Population) Location No. of No. of CLABSI Rate No. of CLABSIs No. of CLABSI Rate Type CLABSIs Central Per 1,000 Central Per 1,000 Line Days Central Line Line Days Central Line Days DaysMedical ICU 170 100,000 1.7 1,200 600,000 2.0Surgical ICU 58 58,000 1.0 600 400,000 1.5 Source: CDC, Division of Healthcare Quality Promotion, First State-Specific Healthcare- Associated Infections Summary Data Report, page 15. 20
  22. 22. How is the SIR interpreted?• Because we can never obtain a hospital’s true “population” data (e.g., all patients for all times), a statistical procedure referred to as “Confidence Interval” is used to estimate the rate surrounding the SIR.• Since estimates have “variability” we use 95% confidence intervals to describe the variability around the estimate. The confidence interval (CI) gives us the range (Upper and Lower Limits of the confidence interval) within which the TRUE value will fall 95% of the time, assuming that the sample data are reflective of the true population. 21
  23. 23. How is the SIR Interpreted? (continued) SIR = 1.00 (Reference Line) Hospital A 95% Confidence Interval Hospital B Hospital C 0.5 1.0 1.5 Standardized Infection Ratio (SIR)Hospital A: If the 95% confidence interval crosses over the Reference Line of 1.0, the hospital’s infection rateIs not different than national experience.Hospital B: If the 95% confidence interval falls completely below Reference Line of 1.0, the hospital’s infectionrate is better (lower) than national experience.Hospital C: If the 95% confidence interval falls completely above the Reference Line of 1.0, the hospital’sinfection rate is worse (higher) than national experience. 22
  24. 24. Preparing for the Release Jim ReiterSenior Vice President for Communications Maryland Hospital Association 23
  25. 25. Webinar Participant Questions *Please follow Operator instructions for submitting a question. Thank you.* 24
  26. 26. Adjournment and Evaluation Questions• Your feedback on this session is very important to us.• We would like to hear from you: Please complete the WebEx Polling Questions on your screen.• Comments can also be faxed (410-358-1311) or emailed to: Pamela W. Barclay Director, Center for Hospital Services Maryland Health Care Commission pbarclay@mhcc.state.md.us Theressa Lee Chief, Hospital Quality Initiatives Maryland Health Care Commission tlee@mhcc.state.md.us 25

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