Comparison of Administrative Database-Derived and Hospital-Derived Data for Monitoring Blood Culture Use in the Pediatric Intensive Care Unit

Author:

Xiao Shaoming1,Woods-Hill Charlotte Z23,Koontz Danielle1,Thurm Cary4,Richardson Troy4ORCID,Milstone Aaron M1,Colantuoni Elizabeth5,Elaine-Marie Albert J6,Zerr Danielle M7,Foster Charles B8,Ezetendu Chidiebere9,Hauger Sarmistha B10,Dallefeld Samantha H11,Sandora Thomas J12,Priebe Gregory P13,Tadphale Sachin D14,Hysmith Nicholas D15,Nolt Dawn16,Kirby Aileen L17,Toltzis Philip18,Clayton Jason A18,Agulnik Asya19,Wolf Joshua20,Newland Jason G21,Lin John C21,Steffen Katherine M22,Schwenk Hayden T23,Flaherty Brian F24,Larsen Gitte Y25,Coffin Susan E26,Fainberg Nina A27,Linam William M28,Smith Craig M2930,Kociolek Larry K29,Hong Sue J29,Miller Marlene R1831,Xie Anping3233,Fackler James C33,

Affiliation:

1. Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

2. Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania , USA

3. The Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania , USA

4. Children’s Hospital Association , Lenexa, Kansas , USA

5. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA

6. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle

7. Division of Infectious Diseases, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle

8. Center for Pediatric Infectious Diseases, Cleveland Clinic Children’s Hospital, Cleveland, Ohio

9. Cleveland Clinic Children’s Hospital, Cleveland, Ohio

10. Division of Pediatric Infectious Disease, Dell Medical School, University of Texas at Austin

11. Division of Pediatric Critical Care, Department of Pediatrics, Dell Medical School, University of Texas at Austin

12. Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts

13. Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine and Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Department of Anesthesia, Harvard Medical School, Boston, Massachusetts

14. Division of Pediatric Critical Care and Cardiology, Department of Pediatrics, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis

15. Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis

16. Doernbecher Children’s Hospital, Oregon Health & Science University, Portland

17. Division of Pediatric Critical Care, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland

18. Rainbow Babies and Children’s Hospital, Cleveland, Ohio

19. Department of Global Pediatric Medicine, Division of Critical Care, St Jude Children’s Research Hospital, Memphis, Tennessee

20. Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee

21. Washington University School of Medicine, St Louis, Missouri

22. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California

23. Department of Pediatrics, Stanford School of Medicine, Stanford, California

24. Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City

25. Division of Critical Care Medicine, Department of Pediatrics, Intermountain Primary Children’s Hospital, University of Utah, Salt Lake City

26. Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia

27. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

28. Emory School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia

29. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois

30. Department of Neurology, Northwestern University Feinberg School of Medicine, Ann & Robert H.Lurie Children’s Hospital of Chicago, Chicago, Illinois

31. Case Western Reserve University School of Medicine, Cleveland, Ohio

32. Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland

33. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Abstract

Abstract Background Optimizing blood culture practices requires monitoring of culture use. Collecting culture data from electronic medical records can be resource intensive. Our objective was to determine whether administrative data could serve as a data source to measure blood culture use in pediatric intensive care units (PICUs). Methods Using data from a national diagnostic stewardship collaborative to reduce blood culture use in PICUs, we compared the monthly number of blood cultures and patient-days collected from sites (site-derived) and the Pediatric Health Information System (PHIS, administrative-derived), an administrative data warehouse, for 11 participating sites. The collaborative’s reduction in blood culture use was compared using administrative-derived and site-derived data. Results Across all sites and months, the median of the monthly relative blood culture rate (ratio of administrative- to site-derived data) was 0.96 (Q1: 0.77, Q3: 1.24). The administrative-derived data produced an estimate of blood culture reduction over time that was attenuated toward the null compared with site-derived data. Conclusions Administrative data on blood culture use from the PHIS database correlates unpredictably with hospital-derived PICU data. The limitations of administrative billing data should be carefully considered before use for ICU-specific data.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,General Medicine,Pediatrics, Perinatology and Child Health

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