Form 5 Clinical Outcomes Data Template

A ttachment I: Clinical Outcomes Data Template

Clinical Outcomes Data

Clinical outcomes data can be submitted in two ways. One, by units who confer data rights to the Center for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) which would eliminate all burden for units to provide Healthcare Associated Infection rates. Or two, for those units who do not confer rights to NHSN or do not submit data to NHSN, can extract these data from their Electronic Health Records (EHR) and submit electronically via the secure program portal. These data can be reported/extracted by infection type - central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia and ventilator-associated adverse events (VAP/VAE).

Clinical outcomes data will be submitted retrospectively, once at baseline for a twelve-month pre-implementation period, and quarterly for the nine-month implementation period.

Data broken down by month

Count of Patient days – monthly

Month, Year	Total patient days

Count of Device days – monthly

Month, Year	Total device associated line days

Count of device-associated infection (CLABSI, CAUTI, and VAP/VAE) cases – monthly

Month, Year	Count of infection cases

Public reporting burden for the collection of information is estimated to average 3.5 hours for the initial response and 30 minutes per quarterly response, the estimated time required to complete this data extraction. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer, Attention: PRA, Paperwork Reduction Project (0935-XXXX), AHRQ, 5600 Fishers Lane, MS 0741A, Rockville, MD 20857.

The confidentiality of your responses is protected by Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. Information that could identify you will not be disclosed unless you have consented to that disclosure.