Iowa Healthcare Collaborative - Iowa Report Data Collection / Tools / Methods

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Iowa Healthcare Collaborative - Iowa Report Data Collection / Tools / Methods Healthcare-Associated Infection (HAI) Measures: Since 2007, Iowa hospitals have voluntarily engaged in data collection, measurement,
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Iowa Healthcare Collaborative - Iowa Report Data Collection / Tools / Methods Healthcare-Associated Infection (HAI) Measures: Since 2007, Iowa hospitals have voluntarily engaged in data collection, measurement, reporting, and improvement activities with the goal of preventing infections. Local surveillance and measurement activities followed the evolving national infection measurement framework established by the Centers for Disease and Control s (CDC) National Healthcare Safety Network (NHSN) system. Infection data are selfreported - collected through an online data collection tool developed and maintained by the Iowa Hospital Association (IHA) and the Iowa Healthcare Collaborative (IHC). The methods used to collect data, measure infections, and publicly report infection outcomes have strengths and limitations. A key strength is that the hospitalspecific and Iowa infection rates calculated for public reporting purposes are based on national infection measurement standards. However; as the national data collection, measurement, and reporting infrastructure evolves the information presented in public reports of hospital performance should be interpreted with caution. Data collection methods include hospitals' self-reported counts of infections that are not verified for accuracy. Therefore, there are limitations associated to the methods used to count infections. Reviewer variability in infection surveillance may exist. The comprehensiveness of infection reporting may vary by hospital due to the extent and types of surveillance mechanisms used to track infections. In addition, hospitals' infection rates shown in reports are observed rates of infections that are not adjusted for patient factors (e.g. - age, severity of illness, clinical stability, extent and severity of comorbidities, length of stay, treatment preferences) or other treatment-related differences (e.g. - types and complexity of services provided by the hospital) that may affect hospitals' rates of infection. For some HAI metrics however; IHC and IHA conduct independent analyses of the State Inpatient Database (SID) and State Outpatient Database (SOD) datasets utilizing CDC NHSN coding criteria to determine denominator counts. Two different analytical tools and methods were used independently by IHC and IHA to analyze Iowa data. The results of these analyses were subsequently compared and verified for accuracy by IHC and IHA. Analyses of the data were conducted by IHA and IHC staff using Microsoft Excel, Access, and SAS (Version 9.2; Cary, North Carolina). 1 Surgical Site s (Hip, Hysterectomy, Colon, CABG) This measure is reported as a rate. The numerator consists of hospitals selfreported count of surgical site infections. The denominator consists of hospitals number of surgical procedures for each type of surgery (CABG, colon, hip, hysterectomy). Numerator Self-reported total number of surgical site infections per surgery type (CABG, colon, hip, hysterectomy) Denominator Total number of hospital discharges (inpatient and outpatient) undergoing specific surgery type (CABG, colon, hip, hysterectomy) o Determined by inpatient ICD-9 codes and outpatient HCPCS-CPT codes specified by CDC-NHSN criteria relevant to each type of surgery. These codes may change from year-to-year. See Table 1 below for the CY 2010 ICD-9 codes used to determine the count of CABG, colon, hip, and hysterectomy inpatient surgeries within each hospital. CPT codes that align with the ICD-9 codes in the table below were used to determine the count of outpatient surgeries. Table 1. CY2010 ICD-9 Codes for SSI Metrics Coronary Artery Bypass Graft (CABG) - Inpatient ICD-9 Code Code Description Aortocoronary bypass for heart revascularization, NOS (Aorto)coronary bypass of one coronary artery (Aorto)coronary bypass of two coronary arteries (Aorto)coronary bypass of three coronary arteries (Aorto)coronary bypass of four coronary arteries Single internal mammary coronary artery bypass Double internal mammary coronary artery bypass Abdominal coronary artery bypass Other bypass anastomosis for heart revascularization Heart revascularization by arterial implant 2 Colon - Inpatient ICD-9 Code Code Description Laparoscopic multiple segmental resection of large intestine Laparoscopic cecectomy Laparoscopic right hemicolectomy Laparoscopic resectin of transverse colon Laparoscopic left hemicolectomy Laparoscopic sigmoidectomy Other laparoscopic partial exicsion of large intestine Incision of large intestine Open biopsy of large instestine Excision of lesion of tissue of large intestine Other destruction of lesion of large intestine Isolation of segment of large intestine Multiple segmental resection of large intestine Cecectomy Right hemicolectomy Resection of transverse colon Left hemicolectomy Sigmoidectomy Other partial excision of large intestine Laparoscopic total intra abdominal colectomy Open total intra abdominal colectomy Other and unspecified total intra abdominal colectomy Anastomosis of small intestine to rectal stump Other small to large intestinal anastomosis Large to large intestinal anastomosis Anastomosis to anus Exteriorization of large intestine Resection of exteriorized segment of large intestine Colostomy, not otherwise specified Temporary colostomy Permanent colostomy Delayed opening of colostomy Other revision of stoma of large intestine Closure of stoma of large intestine Suture of laceration of large intestine Closure of fistula of large intestine Revision of anastomosis of large intestine 3 Hip Arthroplasty - Inpatient ICD-9 Code Code Description Revision of hip replacement, both acetabular and femoral components Revision of hip replacement, acetabular component Revision of hip replacement, femoral component Revision of hip replacement, acetabular liner and/or femoral head only Resurfacing hip, total, acetabulum and femoral head Resurfacing hip, partial, femoral head Resurfacing hip, partial, acetabulum Total hip replacement Partial hip replacement Revision of hip replacement, not otherwise specified Hysterectomy Inpatient ICD-9 Code Code Description Laparoscopic supracervical hysterectomy Other subtotal abdominal hysterectomy, NOS Laparoscopic total abdominal hysterectomy Other and unspecified total abdomional hysterectomy Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy Laparoscopic radical abdominal hysterectomy Other and unspecified radical abdominal hysterectomy Laparoscopic radical vaginal hysterectomy Other and unspecified radical vaginal hysterectomy 4 Denominator Count Verification for All SSIs (CABG, Colon, Hip, Hysterectomy) The Iowa Healthcare Collaborative (IHC) and the Iowa Hospital Association (IHA) independently analyzed and verified the denominator counts of hospital discharges meeting the CDC NHSN denominator inclusion criteria for each type of SSI measure. The Iowa State Inpatient Database (SID) and State Outpatient Database (SOD) datasets were used in these analyses. Inpatient and outpatient surgeries with a principal procedure date in were verified by IHC and IHA. IHC does not have access to year 2011 datasets. Thus, some patients may have been admitted to hospitals in 2010, but were discharged in These 2011 discharge patients are captured by IHA and added to the denominator counts. Reporting Periods Inpatient discharges reporting period captures any discharge in which the patient undergoes a principal surgical procedure from January 1, 2009 through December 31, Outpatient discharges - reporting period is January 1, 2009 through December 31, 2010 for same-day surgical discharges. Report Characteristics The CABG surgical site infection report is limited to only those hospitals that conducted CABG surgeries. The colon, hip, and hysterectomy surgical site infection reports show all Iowa hospitals. Hospitals that did not perform a particular surgery are denoted on the report with a denominator equal to zero. The Iowa average rate was calculated as the average of all patient-level data within hospitals that reported all 12 months of data. Hospitals that did not report data for all 12 months were excluded from the calculation of the Iowa statewide average. The calculation of the Iowa average rate is inclusive of those hospitals that reported a full 12 months of data and conducted less than 25 total surgeries during the reporting period. For comparative purposes national averages for each SSI metric were calculated using national CDC-NHSN data published by the CDC. For each SSI metric the national average was calculated as the total number of infections divided by the total number of surgical procedures across all risk index categories (stratifications of patient risk). Central Line-Associated Bloodstream Infection (CLABSI) This measure is reported as a rate. The numerator consists of hospitals selfreported numbers of central line bloodstream infections in medical, surgical, and combined medical/surgical ICU settings. The denominator consists of hospitals self- 5 reported number of central line catheter days within medical, surgical, and medical /surgical ICUs. The measure excludes bone marrow transplant units and nursing areas that provide step-down, intermediate care, or telemetry only. The measure also excludes NICUs, PICUs, Burn Units, and stand-alone coronary care units. Coronary patients within medical/surgical ICU settings are included in the metric. Numerator Self-reported total number of central line-associated bloodstream infections o Reported number of laboratory-confirmed primary bloodstream infections in medical/surgical ICUs or within 48 hours of leaving the ICU. o The patient is followed for 48 hours after transfer to another unit. If a BSI develops within that 48 hour period, the infection is attributed to the original unit. o Infections are reported in the month that the patient was discharged and summed to yield a yearly total. Denominator Self-reported total number of central line days within medical/surgical ICUs o Reported number of central line days associated to medical, surgical, or combined medical/surgical ICU patients. Reporting Periods Inpatient discharges - reporting period is January 1, 2009 through December 31, Report Characteristics This measure is applicable to those hospitals with a medical or surgical ICU as reported in the IHA Annual Survey and performed at least one central line insertion. Hospitals that do not have a medical or surgical ICU are denoted on the report with a denominator equal to zero. The Iowa average rate was calculated as the average of all patient-level data within hospitals that reported all 12 months of data within a calendar year reporting period. Hospitals that did not report data for all 12 months were excluded from the calculation of the Iowa statewide average. The calculation of the Iowa average rate is inclusive of those hospitals that reported a full 12 months of data and had less than 50 total catheter days during the reporting period. For comparative purposes national averages for CLABSI were calculated using national CDC-NHSN data published by the CDC. The national CLABSI average was calculated as the total number of CLABSI infections divided by the total number of central line days for the following types of medical/surgical critical care units: medical 6 major teaching, medical all others, medical/surgical major teaching, medical/surgical all others = 15 beds, medical/surgical all others 15 beds, and surgical. MRSA Surgical Site Infections This measure is reported as a rate. The numerator consists of hospitals selfreported number of CABG, colon, hip, and hysterectomy discharges that experienced a MRSA surgical site infection. The denominator consists of hospitals total discharges for CABG, colon, hip, and hysterectomy surgeries. Numerator Self-reported total number of MRSA infections Denominator Total number of hospital discharges undergoing CABG, colon, hip, and hysterectomy surgeries o Determined by inpatient ICD-9 codes and outpatient HCPCS-CPT codes specified by CDC-NHSN criteria relevant to each type of surgery. These codes may change from year-to-year. Table 1 lists the CY 2010 ICD-9 codes used to determine the count of all CABG, colon, hip, and hysterectomy surgeries within each hospital. CPT codes that align with the ICD-9 codes listed in Table 1 were used to determine the total count of outpatient surgeries. Denominator Count Verification for MRSA surgical site infections The Iowa Healthcare Collaborative (IHC) and the Iowa Hospital Association (IHA) independently analyzed and verified the denominator counts of hospital discharges meeting the CDC NHSN denominator inclusion criteria for each type of SSI measure using the Iowa State Inpatient Database (SID) and State Outpatient Database (SOD) datasets. Inpatient and outpatient surgeries with a principal procedure date in were verified by IHC and IHA. IHC does not have access to year 2011 datasets. Thus, some patients may have been admitted to hospitals in 2010, but were discharged in These 2011 discharge patients are captured by IHA and added to the denominator counts. Reporting Periods Inpatient discharges reporting period captures any discharge in which the patient undergoes a principal surgical procedure from January 1, 2009 through December 31, Outpatient discharges - reporting period is January 1, 2009 through December 31, Report Characteristics The colon, hip, and hysterectomy surgical site infection reports show all Iowa hospitals. Hospitals that did not perform any of these surgeries are denoted on the report with a denominator equal to zero. The Iowa average rate was calculated as the average of all patient-level data within hospitals that reported all 12 months of data. Hospitals that did not report data for all 12 months were excluded from the calculation of the Iowa statewide average. The calculation of the Iowa average rate includes those hospitals that reported a full 12 months of data, yet conducted less than 25 total surgeries during the reporting period. MRSA Bloodstream Infection This measure is reported as a rate. The numerator consists of hospitals selfreported number of patients that experienced a MRSA bloodstream infection. The denominator consists of hospitals total number of inpatient days (total length of stay) for acute care and swing/skilled Nursing Facility (SNF) patients. Numerator Self-reported total number of MRSA bloodstream infections Denominator Total number of inpatient days for all acute care/swing bed/skilled nursing facility (SNF) discharges o No hospital had less than 25 inpatient days. Denominator Count Verification for MRSA bloodstream infections The Iowa Healthcare Collaborative (IHC) and the Iowa Hospital Association (IHA) independently analyzed and verified the denominator counts for this measure using the Iowa State Inpatient Databases (SID). A sum of all acute care and swing/snf (Service Code = 1 and 3 in SID) discharges total length of stay (LOS) was calculated and verified for each hospital. Reporting Periods Reporting period captures any acute care and swing/snf discharge from January 1, 2009 through December 31, Report Characteristics The Iowa average rate was calculated as the average of all patient-level data within hospitals that reported all 12 months of data. Hospitals that did not report data for all 12 months were excluded from the calculation of the Iowa statewide average. 8 Healthcare Worker Influenza Immunization This measure is reported as a rate. The numerator consists of hospitals selfreported numbers of employees receiving a seasonal influenza vaccination during the flu season. Employee vaccination could occur inside or outside the hospital. The denominator consists of hospitals self-reported number of employees receiving a paycheck. Numerator Self-reported total number of employees vaccinated with seasonal flu vaccine (H1N1 vaccination is not included in this measure) o The number of employees who received the seasonal influenza vaccination during the vaccination campaign season (flu season). o Each person is counted once. o Includes employees that received the vaccination on-site as well as those who were vaccinated at other locations. Denominator Self-reported total number of employees receiving a hospital paycheck o The total number of employees receiving a paycheck during the vaccination campaign season o Each person is counted once. o Focus is only on hospital employees. The denominator count does not include other hospital workers that do not receive a paycheck (E.g students, volunteers). Reporting Periods Previous flu seasons - October 1 through March reporting period was October 1, 2010 through March 31, Report Characteristics The Iowa average rate was calculated as an average of all employee-level data reported by hospitals. All hospitals that reported complete HCW immunization data were included in the calculation of the Iowa statewide average. Comparative national rates of healthcare worker (HCW) flu vaccination were gathered from National Health Interview Survey (NHIS) data published by the CDC. 9 HCW Vaccination Survey Results Fall 2010 Survey In the fall of 2010, infection prevention professionals in Iowa s acute hospitals completed an online vaccination survey designed to identify policies, tools, and processes being used to measure and improve healthcare worker (HCW) flu vaccination rates. Several survey questions asked about evidence-based policies, tools and processes shown to be efficacious in increasing flu vaccination levels among HCWs. The great majority of hospitals (109 of % response rate) responded to the survey. Results for select survey questions are shown below. Access to Vaccine for Employees Survey Question Did your facility have difficulty accessing sufficient supplies of the regular seasonal influenza vaccine for employees for the campaign (previous season)? Survey Question Do you provide input regarding your anticipated need for seasonal influenza vaccine for employees to your facility s pharmacy manager when ordering seasonal influenza vaccine? Survey Response Response Frequency (n) % No response % Yes % No % Survey Response Response Frequency (n) % No response % Yes % No 9 8.3% Survey Question If your facility experienced an influenza vaccine shortage for your employees, which of the following responses would be available to you? Notes: Other vaccine shortage responses: Wait until order/supply vaccine arrived Contact Iowa Dept of Public Health for assistance Contact County Health Dept for assistance Work with different manufacturers / vaccine suppliers Pharmacy seeks other supplies Contact another pharmacy Survey Response Response Frequency (n) Contact other affiliated hospitals to consider a reallocation to relieve the 31 shortage Contact other non-affiliated hospitals to consider a reallocation to relieve 23 the shortage Work with other healthcare providers in our geographic area to fulfill the 47 need Other (please specify) 25 Vaccinate HCW at high risk first, then other staff as vaccine becomes available 10 Use of a Consent/Declination Form Survey Question Does your facility use a consent/declination form for purposes of collecting information from employees relating to their receipt or refusal to receive a seasonal influenza vaccination? Survey Response Response Frequency (n) % Yes - Custom Form % Yes - Standard Form % No 4 3.7% Survey Question If your facility has a customized form, identify the types of information that your form includes (Mark all that apply) Survey Response Response Frequency (n) % of All Custom Form Use Responders Staff/Non-staff name % Unique Staff/Non-staff identifier (ID) % Reasons for medical contraindication to vaccination % List of other reasons for refusal of vaccination (E.g. Allergy/hypersensitivity to eggs or vaccine component (type of reaction must be specified), allergy to thimerosal, History of Guillian-Barre syndrome within 6 weeks following a previous influenza v
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