Significant variation in the way hospitals measure and report acquired bloodstream infections points to problems with payment incentives and databases that compare institutions, according to a report published in Tuesday's Journal of the American Medical Association.
"Our findings suggest that there is local variation in central line-associated BSI surveillance performance at different medical centers, raising concern for the validity of inter-institutional rate comparisons," wrote the authors.
The researchers, including Michael Lin, MD, of Rush University Medical Center and others with the Centers for Disease Control and Prevention Prevention Epicenters Program, note that "hospital reimbursement is increasingly dependent on reported rates."
This, they said, creates "potential financial incentives for hospitals to underreport rates. Our study highlights the potential fallibility of traditional surveillance methods using partially subjective criteria and underscores the need for cautious interpretation of these results until more reliable measures or validation against objective measures can routinely be performed."
The researchers examined practices over 12-month periods at 20 intensive care units within four academic training medical centers "with strong interest in infection prevention and research." They used a computer algorithm reference standard that they applied retrospectively using criteria that adapted the same CDC surveillance definitions.