"Not only did they examine the patients, they were allowed to look at the entire medical record, the doctors' notes, the wound care specialists' notes, the nurses' notes," Meddings says. "They had all the data and they were looking at the patients with their own eyes, which is quite different as opposed to the billing data."
The study's HAPU findings are consistent with a similar review Meddings' team conducted last year of catheter-associated urinary tract infections at California hospitals.
"We know the use of the catheters and skin conditions is much better documented in nurses' notes rather than doctors' notes because nurses are providing much of the skin care and they routinely do the skin exams and they are also the providers who place and monitor the urinary catheters," she says. "Both of these complications are essentially easy to find in nurses' notes, but very hard to find in the notes that coders are allowed to look at."
Continued use of claims data as a measure of hospital HAIs also misinforms the public. "One of our biggest concerns is that there seems to be a trend of quickly using data to publicly report because the data is available and only asking questions years later of whether or not their data is accurate. These types of assessments should have been done before the data was publicly released," she says.