State-Mandated Hospital Infection Reporting Is Not Associated With Decreased Pediatric Health Care-Associated Infections

Abstract

Objectives: State governments increasingly mandate public reporting of central line-associated blood stream infections (CLABSIs). This study tests if hospitals located in states with state-mandated, facility-identified, pediatric-specific public CLABSI reporting have lower rates of CLABSIs as defined by the Agency for Healthcare Research and Quality's Pediatric Quality Indicator 12 (PDI12).

Methods: Utilizing the Kids' Inpatient Databases from 2000 to 2009, we compared changes in PDI12 rates across three groups of states: states with public CLABSI reporting begun by 2006, states with public reporting begun by 2009 and never-reporting states. In the baseline period (2000-2003), no states mandated public CLABSI reporting. A multivariable, hospital-level random intercept, logistic regression was performed comparing changes in PDI12 rates in states with public reporting to changes in PDI12 rates in never-reporting states.

Results: 4,705,857 discharge records were eligible for PDI12. PDI12 rates significantly decreased in all reporting groups, comparing baseline to the post-public reporting period (2009): Never Reporters 88% decrease (95% CI, 86%-89%), Reporting Begun by 2006 90% decrease (95% CI, 83%-94%), and Reporting Begun by 2009 74% decrease (95% CI, 72%-76%). The Never Reporting Group had comparable decreases in PDI12 rates to the Reporting Begun by 2006 group (P = 0.4) and significantly larger decreases in PDI12 rates compared to the Reporting Begun by 2009 group (P < 0.001), despite having no states with public reporting.

Conclusions: Public CLABSI reporting alone appears to be insufficient to affect administrative data-based measures of pediatric CLABSI rates or children may be inadequately targeted in current public reporting efforts.

Figure 1. Adjusted PDI12 Rates per 1,000 Eligible Discharges by State-Mandated Public Reporting Groups (Never Reporters, Reporting Begun by 2006 and Reporting Begun by 2009)

Healthcare-associated infections were defined by the Agency for Healthcare Research and Quality’s administrative data based Pediatric Quality Indicator Tool (PDI12).. Model was adjusted for patient age in years, gender, expected primary payer, number of procedures, number of diagnoses, hospital bed size, hospital location and hospital teaching status. Model assumed random effects at the hospital level. *Adjusted PDI12 rates statistically significantly decreased for all three groups comparing their respective baseline rates to their 2006 or 2009 rates (p<0.001).