High stakes and low rates

The recent scandal surrounding a college that submitted inflated SAT scores to improve their ranking in the US News & World Report should remind us of a simple fact—the higher the stakes, the more likely cheating will occur.

Now that CMS is publishing ICU CLABSI data on their hospital compare website, and using the data in payment formulas, the stakes for hospitals could hardly be higher. And available data suggests that many hospitals stray from strict application of NHSN definitions, reporting misleadingly low CLABSI rates. We’ll soon be publishing results from a survey we did of hundreds of infectious diseases clinicians involved in CLABSI reporting at their institutions. Given patient scenarios that clearly met the NHSN definition for primary CLABSI, what percent do you think responded that they would report them as primary CLABSIs? I can’t go into detail given that this is as-yet-unpublished data, but I suspect the results will surprise even those most critical of publicly-reported HAI data. So I’m dismayed when I read quotes like “several hospitals that serve the sickest patients have been able to achieve infection rates of zero for several years”. The statement is obviously false—but even if it were true, it simply means that the hospital isn’t applying NHSN definitions correctly.