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Background: In response to the growing concern about healthcare-associated infections (HAIs), US Department of Health and Human Services (HHS) developed the National Action Plan to Prevent Healthcare-associated Infections. A key focus of the Action Plan is the setting of HAI metrics and targets and the enhancement and development of data systems to support HAI surveillance., Objectives: To identify and assess the strengths and weaknesses of HHS data systems available for surveillance of catheter-associated urinary tract infections, surgical site infections, and Clostridium difficile infections. To present national data from each of the data systems and assess concordance in trends over time., Research Design: Literature review on data system characteristics and HAI measurement. Graphical and descriptive analyses of longitudinal HAI rates from HHS data systems., Measures: HAI rate information expressed as prevalence rates or standardized infection ratios., Results: We identified four HHS data systems--Medicare claims data, Healthcare Cost and Utilization Project, Medicare Patient Safety Monitoring System, and National Healthcare Safety Network--capable of surveillance of at least one of the HAIs under study. Surgical site infection and Clostridium difficile infection rates display concordance in trends, although there is no evidence of concordance in catheter-associated urinary tract infections rates. We have identified a number of desirable HAI data system characteristics: clinically valid; provide information on a broad range of HAIs; have large sample size to support statistical inference; be representative of the United States; and display consistency in cohort, surveillance protocols, and data collection methodology., Conclusions: Although the data systems included in this study vary along the desirable data system dimensions we identified, trends in HAI rates are generally concordant across the data systems. This increases confidence in observed trends.

Background: Comprehensive geriatric assessment (CGA) can be effective in inpatient units, but such inpatient settings are prohibitively expensive. If similar benefits could be obtained in outpatient settings, CGA might be a more attractive option., Objectives: To assess the cost-effectiveness (CE) of an outpatient geriatric assessment with an intervention to increase adherence., Subjects: Three hundred fifty-one community-dwelling, elderly subjects with at least one of four geriatric conditions., Measures: In addition to the measures of functioning, we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention., Results: The intervention, which prevented functional decline, cost $273 per participant. The intervention group averaged three more visits than the control group in the first 32 weeks after the intervention, but only 1.2 extra visits in the next 32 weeks. We estimate that the costs of these additional medical services would be $473 for the 5 years after the intervention, leading to a total cost per Quality Adjusted Life Year (QALY) of $10,600., Conclusions: The CE of this program compares favorably with many common medical interventions. Whether investments should be made in health care resources on treatments that lead to modest improvements in the functioning of community-dwelling elderly people remains a societal decision.