Using Inpatient Discharge Data to Evaluate Efforts to Improve Perinatal HIV-Exposure Reporting in Pennsylvania 2011 - 2013

BACKGROUND:   In 2002 Pennsylvania disease reporting regulations were amended to require the reporting of perinatal exposure to HIV for infants born to HIV positive women with retrospective review back to 2000. In 2011, the Pennsylvania Department of Health initiated efforts to improve reporting of perinatal exposure to HIV that included conducting outreach efforts to major birthing hospitals, requests for facilities to identify potential cases of exposure using pharmacy claims data, and matching data for women of child bearing age in the HIV surveillance database to the Pennsylvania birth registry data. The objective of this evaluation is to demonstrate the value of using hospital discharge data to evaluate the success of these efforts to improve reporting of perinatal exposure.    

METHODS:   ICD9 diagnostic and procedure codes in hospital discharge data were used to identify the number of women who gave birth and  were also HIV infected by facility of   and year birth between 2011 and 2013. HIV surveillance data were used to assess how many pediatric HIV exposures were reported  by facility  during the same time period.

RESULTS:   Comparing the number of pediatric exposures by facility between HIV surveillance database and hospital discharge data showed that approximately 86% of all exposures reported in hospital discharge data that occurred over the three-year period were identified as pediatric exposures in the surveillance data. The hospital discharge data indicated that the average number of perinatally-HIV-exposed infants was 83 per year of which an average of 70 infants were identified by surveillance activities. Approximately 20 hospitals with under-reported cases during 2011 through 2013 were also identified.

CONCLUSIONS: Hospital discharge record may be useful for estimating completeness of  perinatal exposure to HIV and identifying facilities with potential under-reporting of cases. However, hospital discharge data should not be viewed as the gold standard for estimating the incidence  of perinatal HIV exposure because these discharge data may be subject to error and do not account for instances of multiple birth. Follow-up with the specific facilities with potentially under-reported cases will be implemented  to confirm these preliminary findings.