I spent about 2 hours with the new CDC HAI Progress Report –
loosen your belt, it’s a big meal! We
probably had mixed perceptions about the recent alert to the 2016 HA progress
report. Loads of information and analysis condensed down to a handful of bullets,
all pointing to improvements in patient safety! The (very pleasant) surprise to
me was that the format and delivery of the report has advanced to digital!! CDC
has added the HAI progress report to the existing (and now updated) HAI AR Patient
Safety Atlas Portal If you stop reading now – at least click on that link and
explore and I will call this blog a success!
This report is several steps forward. First, it pushes all of us to go to a place
where we, being inquisitive minds, can wander and perhaps connect some dots
within and between datasets. With the digitalization and visualization provided
in the portal, the novice and experienced can more easily access and utilize
these data. One can click through four distinct datasets, which now include
state-summary statistics HAI infection rates/SIRs, inpatient stewardship
activities, outpatient antibiotic prescribing rates, and inpatient antibiotic
resistance metrics.
Now – the email alert. This year, well 2016 data, is the
first to use the 2015 “re-baseline” efforts.
Unstated, but implied – the re-baseline effort includes the use of MBI (mucosal barrier injury) LCBSI as an event
excluded from reported CLABSI rates, exclusion of yeasts (or low colony counts)
from CAUTI rates, exclusion of “infection present on admission” for SSI (along with
better patient-level risk adjustment), first use of risk adjusted metrics for
VAE, and maybe slightly better models using more contemporary data for MRSA and
CDI.
With that said, 2016 performance suggests nationally patients are safer
overall compared to the experience of 2015. Other than VAE which decreased by
only 2%, everything else declined about 7-10% (I am rounding) compared to 2015.
I understand many of the problems with risk adjustment and reporting bias that
make these surveillance events poor performance measures for individual hospitals
– but on the national level – I think
these data do suggest fewer infections (o.k., perhaps some widespread under-reporting—mixed reports on
validation efforts in place).
Next – the overview of the current HAI Progress Report. Although at first glance it seems the same as
the info posted in the emails – CDC is offering more ways to track progress
nationally – the number of states showing improvements (or worsening) compared to
2015, as well as the number states currently performing at levels better (or
worse) then their 2016 contemporaries: 12 state perform better on at least 3
infection types compared to other states at the same time (2016). Now positive deviance nerds need to learn from these states to help the other states (or perhaps identify accuracy and
validation issues at these states). The contemporary juxtaposition of SIRs is new, perhaps
confusing (especially with CDC’s arcane explanation on how to interpret this: “SIRs
statistically significantly lower than the 2016 national SIR are considered
better than the 2016 national SIR”; curious if it ends up being useful to state
programs. This year also is the first with more detail on inpatient rehabilitation facilities and
long-term acute care facilities. Fewer
data mean fewer statistical significant results, but these data are ripe for
academic partners to latch onto as they try to partner with ARHQ, CDC, and
state-programs to branch out into stewardship and prevention efforts in these
types of facilities.
Finally, the portal – access it here. Use the table view. No graphics to export for HAIs, only for other datasets. My
pet peeve is that CDC still refused to list the no. of SSIs reported next to
the number of surgical procedures reported to allow a crude attack rate. We
still need to go to the technical tables for these values and calculate ourselves (see below). CDC, please stop making us
jump through this hoop to be able to use attack rates for other purposes like planning
studies, clinical trials, vaccine research! To all researchers and data nerds - the detailed technical tables should be downloaded examined (here), perhaps parsed out to our students and trainees, and used for
different purposes that simply a “reporting requirement”. I know there are many limitations to the
accuracy of any one facilities reports and likely aggregate data up to the
state or national level. However, as a long time national surveillance nerd all
too familiar with the warts and ugliness of surveillance data, they do inform
us, approximate the truth, and can help us ask the right questions and target
the right populations. The more eyes using these data the more transparent the
process will become, more uses of the data will be identified, patient safety
should improve, and CDC will become more accountable to update (c’mon, where’s
2015 and 2016 NHSN AR data?! update the portal please!!), maintain, and advance the public accessibility
of useful data in our field.
