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Use of Medicare Claims to Rank Hospitals by Surgical Site Infection Risk following Coronary Artery Bypass Graft Surgery

Published online by Cambridge University Press:  02 January 2015

Susan S. Huang ,
Hilary Placzek ,
James Livingston ,
Allen Ma ,
Fallon Onufrak ,
Julie Lankiewicz ,
Ken Kleinman ,
Dale Bratzler ,
Margaret A. Olsen  and
Rosie Lyles
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Susan S. Huang*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Hilary Placzek
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
James Livingston
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Allen Ma
Affiliation:
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma
Fallon Onufrak
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Julie Lankiewicz
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Ken Kleinman
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Dale Bratzler
Affiliation:
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Rosie Lyles
Affiliation:
Department of Medicine, Cook County Hospital, Chicago, Illinois
Yosef Khan
Affiliation:
Department of Infection Control, Ohio State University School of Medicine, Columbus, Ohio
Paula Wright
Affiliation:
Department of Infection Control, Massachusetts General Hospital, Boston, Massachusetts
Deborah S. Yokoe
Affiliation:
Channing Laboratory, Department of Medicine and Department of Infection Control, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Robert A. Weinstein
Affiliation:
Department of Medicine, Cook County Hospital, Chicago, Illinois
Kurt Stevenson
Affiliation:
Department of Infection Control, Ohio State University School of Medicine, Columbus, Ohio
David Hooper
Affiliation:
Department of Infection Control, Massachusetts General Hospital, Boston, Massachusetts
Johanna Vostok
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Rupak Datta
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Wato Nsa
Affiliation:
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma
Richard Platt
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Channing Laboratory, Department of Medicine and Department of Infection Control, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
*
University of California Irvine School of Medicine, Division of Infectious Diseases, 101 City Drive South, City Tower, Suite 400, ZC 4081, Orange, CA 92868-3217 (sshuang@uci.edu)
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Abstract

Objective.

To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates.

Design.

We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix–adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery. We then reviewed medical records of randomly selected patients to assess whether chart-confirmed SSI risk was higher in hospitals in the worst deciles compared with the best deciles.

Participants.

Fee-for-service Medicare beneficiaries who underwent CABG in these hospitals in 2005.

Results.

We evaluated 114,673 patients who underwent CABG in 671 hospitals. In the best decile, 7.8% (958/12,307) of patients had an SSI-related code, compared with 24.8% (2,747/11,068) in the worst decile (P<.001). Medical record review confirmed SSI in 40% (388/980) of those with SSI-related codes. In the best decile, the chart-confirmed annual SSI rate was 3.2%, compared with 9.4% in the worst decile, with an adjusted odds ratio of SSI of 2.7 (confidence interval, 2.2–3.3; P<.001) for CABG performed in a worst-decile hospital compared with a best-decile hospital.

Conclusions.

Claims data can identify groups of hospitals with unusually high or low post-CABG SSI rates. Assessment of claims is more reproducible and efficient than current surveillance methods. This example of secondary use of routinely recorded electronic health information to assess quality of care can identify hospitals that may benefit from prevention programs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 8 , August 2011 , pp. 775 - 783
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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