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Administration of Dexamethasone for Bacterial Meningitis: An Unreliable Quality Measure
Shefali Dujari1, Santosh Gummidipundi2, Zihuai He2
1Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA.
Objective:
To validate the use of administrative data to identify patients with bacterial meningitis and quantify the rate of dexamethasone administration as defined in the American Academy of Neurology Inpatient and Emergency Care Quality Measurement Set.
Methods:
The Vizient Clinical Data Base and Resource Manager was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) codes for bacterial meningitis from October 2015 to June 2019. Chart review was performed on patients identified at a single quaternary-care hospital. The positive predictive value (PPV) of Vizient was determined. Demographic, clinical, and laboratory data were assessed using descriptive statistics.
Results:
Of all hospitals that submitted complete data to Vizient during the study period, a median of 19 patients per hospital had ICD-10 codes for bacterial meningitis in the 45-month period. We identified 79 patients using Vizient at our institution of whom 69 had a diagnosis of bacterial meningitis confirmed by chart review (PPV = 87%). 15 patients were eligible to receive dexamethasone per the quality measurement set. Six of these patients (40%) received dexamethasone.
Conclusion:
It is feasible to use the Vizient Clinical Data Base and Resource Manager to identify patients with bacterial meningitis. Due to low prevalence across multiple institutions and high rate of exclusion criteria at our institution, this study suggests that the rate of dexamethasone administration in bacterial meningitis may be an unreliable indicator of quality of care provided by inpatient neurologists. The creation of a registry for hospitalized neurology patients could enhance development of future quality measures.
Insights
Administrative data can identify bacterial meningitis patients, but dexamethasone use may not reliably indicate neurologist quality of care due to low prevalence and exclusions.
Area of Science:
- Neurology
- Health Informatics
- Quality Improvement
Background:
- Bacterial meningitis diagnosis and treatment quality are critical.
- Administrative data offers potential for quality measurement.
- The American Academy of Neurology (AAN) developed quality measures for inpatient and emergency care.
Purpose of the Study:
- To validate administrative data for identifying bacterial meningitis patients.
- To quantify dexamethasone administration rates in bacterial meningitis cases.
Main Methods:
- Utilized Vizient Clinical Data Base and Resource Manager with ICD-10 codes for bacterial meningitis (Oct 2015-June 2019).
- Conducted chart review at a quaternary-care hospital to determine the positive predictive value (PPV) of Vizient data.
- Analyzed demographic, clinical, and laboratory data using descriptive statistics.
Main Results:
- Vizient identified 79 patients; chart review confirmed 69 cases (PPV = 87%).
- 15 patients met criteria for dexamethasone; 6 (40%) received it.
- Median of 19 bacterial meningitis cases per hospital identified via administrative data.
Conclusions:
- Vizient data effectively identifies bacterial meningitis patients.
- Dexamethasone administration rate may be an unreliable quality indicator due to low prevalence and high exclusion rates.
- A registry for hospitalized neurology patients could improve future quality measure development.
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