Association of Surgical Care Improvement Project Infection-Related Process Measure Compliance with Risk-Adjusted Outcomes: Implications for Quality Measurement

被引:132
|
作者
Ingraham, Angela M. [1 ,2 ]
Cohen, Mark E. [2 ]
Bilimoria, Karl Y. [3 ]
Dimick, Justin B. [4 ]
Richards, Karen E. [2 ]
Raval, Mehul V. [2 ,3 ]
Fleisher, Lee A. [5 ]
Hall, Bruce L. [6 ,7 ,8 ,9 ,10 ]
Ko, Clifford Y. [2 ,11 ,12 ]
机构
[1] Univ Cincinnati, Dept Surg, Coll Med, Cincinnati, OH 45267 USA
[2] Amer Coll Surg, Div Res & Optimal Patient Care, Chicago, IL USA
[3] Northwestern Univ, Dept Surg, Feinberg Sch Med, Chicago, IL 60611 USA
[4] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA
[5] Univ Penn Hlth Syst, Dept Anesthesia, Philadelphia, PA USA
[6] John Cochran Vet Affairs Med Ctr, Dept Surg, St Louis, MO USA
[7] Washington Univ, Sch Med, Dept Surg, St Louis, MO 63110 USA
[8] Barnes Jewish Hosp, St Louis, MO 63110 USA
[9] Washington Univ, Ctr Hlth Policy, St Louis, MO USA
[10] Washington Univ, Olin Business Sch, St Louis, MO USA
[11] Univ Calif Los Angeles, Dept Surg, Los Angeles, CA 90024 USA
[12] VA Greater Los Angeles Healthcare Syst, Los Angeles, CA USA
关键词
PERFORMANCE-MEASURES; HOSPITAL QUALITY; US HOSPITALS; PROGRAM; SURGERY; COMPARE; NSQIP;
D O I
10.1016/j.jamcollsurg.2010.09.006
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Facility-level process measure adherence is being publicly reported. However, the association between measure adherence and surgical outcomes is not well-established. Our objective was to determine the degree to which Surgical Care Improvement Project (SCIP) process measures are associated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk-adjusted outcomes. STUDY DESIGN: This cross-sectional study included hospitals participating in the ACS NSQIP and SCIP (n = 200). ACS NSQIP outcomes (30-day overall morbidity, serious morbidity, surgical site infections [SSI], and mortality) and adherence to SCIP SSI-related process measures (from the Hospital Compare database) were collected from January 1, 2008, through December 31, 2008. Hospital-level correlation coefficients between compliance with 4 process measures (ie, antibiotic administration within 1 hour before incision [SCIP-1]; appropriate antibiotic prophylaxis [SCIP-2]; antibiotic discontinuation within 24 hours after surgery [SCIP-3]; and appropriate hair removal [SCIP 6]) and 4 risk-adjusted outcomes were calculated. Regression analyses estimated the contribution of process measure adherence to risk-adjusted outcomes. RESULTS: Of 211 ACS NSQIP hospitals, 95% had data reported by Hospital Compare. Depending on the measure, hospital-level compliance ranged from 60% to 100%. Of the 16 correlations, 15 demonstrated nonsignificant associations with risk-adjusted outcomes. The exception was the relationship between SCIP-2 and SSI (p = 0.004). SCIP-1 demonstrated an intriguing but nonsignificant relationship with SSI (p = 0.08) and overall morbidity (p = 0.08). Although adherence to SCIP-2 was a significant predictor of risk-adjusted SSI (p < 0.0001) and overall morbidity (p < 0.0001), inclusion of compliance for SCIP-1 and SCIP-2 caused only slight improvement in model quality. CONCLUSIONS: Better adherence to infection-related process measures over the observed range was not significantly associated with better outcomes with one exception. Different measures of quality might be needed for surgical infection. (J Am Coll Surg 2010; 211: 705-714. (C) 2010 by the American College of Surgeons)
引用
收藏
页码:705 / 714
页数:10
相关论文
共 14 条
  • [1] The holy grail of surgical quality improvement: Process measures or risk-adjusted outcomes?
    Rogers, Selwyn O., Jr.
    [J]. AMERICAN SURGEON, 2006, 72 (11) : 1046 - 1050
  • [2] The National Surgical Quality Improvement Project (NSQIP) - using a risk-adjusted surgical outcomes database for performance improvement
    Fuchshuber, P.
    Greif, W.
    Tidwell, Ch
    [J]. E-MEMOIRES DE L ACADEMIE NATIONALE DE CHIRURGIE, 2011, 10 (02): : 52 - 56
  • [3] Risk-adjusted inpatient mortality rate and the Surgical Care Improvement Project
    Stulberg, Jonah J.
    Koroukian, Siran M.
    Aron, David C.
    Fu, Pingfu
    Neuhauser, Duncan V.
    Delaney, Conor P.
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2009, 209 (03) : S94 - S94
  • [4] Using risk-adjusted outcomes to measure quality of care in nursing homes
    Rosen, A
    Mukamel, D
    Kader, B
    Wang, F
    Tsilimingras, D
    Berlowitz, D
    [J]. GERONTOLOGIST, 2003, 43 : 591 - 591
  • [5] Validating risk-adjusted surgical outcomes: chart review of process of care
    Gibbs, J
    Clark, K
    Khuri, S
    Henderson, W
    Hur, K
    Daley, J
    [J]. INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, 2001, 13 (03) : 187 - 196
  • [6] Monitoring the evolutionary process of quality: Risk-adjusted charting to track outcomes in intensive care
    Cook, DA
    Steiner, SH
    Cook, RJ
    Farewell, VT
    Morton, AP
    [J]. CRITICAL CARE MEDICINE, 2003, 31 (06) : 1676 - 1682
  • [7] Risk-adjusted infection rates in surgery:: a model for outcome measurement in hospitals developing new quality improvement programmes
    Gulácsi, L
    Kiss, ZT
    Goldmann, DA
    Huskins, WC
    [J]. JOURNAL OF HOSPITAL INFECTION, 2000, 44 (01) : 43 - 52
  • [8] Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-adjusted Clinical Outcomes After National Implementation A Longitudinal Study
    Mayer, Erik K.
    Sevdalis, Nick
    Rout, Shantanu
    Caris, Jochem
    Russ, Stephanie
    Mansell, Jenny
    Davies, Rachel
    Skapinakis, Petros
    Vincent, Charles
    Athanasiou, Thanos
    Moorthy, Krishna
    Darzi, Ara
    [J]. ANNALS OF SURGERY, 2016, 263 (01) : 58 - 63
  • [9] Re: Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-Adjusted Clinical Outcomes after National Implementation: A Longitudinal Study
    Wang, David S.
    [J]. JOURNAL OF UROLOGY, 2016, 196 (02): : 464 - 464
  • [10] The Department of Veterans Affairs' NSQIP - The first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care
    Khuri, SF
    Daley, J
    Henderson, W
    Hur, K
    Demakis, J
    Aust, JB
    Chong, V
    Fabri, PJ
    Gibbs, JO
    Grover, F
    Hammermeister, K
    Irvin, G
    McDonald, G
    Passaro, E
    Phillips, L
    Scamman, F
    Spencer, J
    Stemple, JF
    [J]. ANNALS OF SURGERY, 1998, 228 (04) : 491 - 504