TY - JOUR
T1 - Adherence to surgical care improvement project measures and the association with postoperative infections
AU - Stulberg, Jonah J.
AU - Delaney, Conor P.
AU - Neuhauser, Duncan V.
AU - Aron, David C.
AU - Fu, Pingfu
AU - Koroukian, Siran M.
PY - 2010/6/23
Y1 - 2010/6/23
N2 - Context: The Surgical Care Improvement Project (SCIP) aims to reduce surgical infectious complication rates through measurement and reporting of 6 infectionprevention process-of-care measures. However, an association between SCIP performance and clinical outcomes has not been demonstrated. Objective: To examine the relationship between SCIP infection-prevention processof-care measures and postoperative infection rates. Design, Setting, Participants: A retrospective cohort study, using Premier Inc's Perspective Database for discharges between July 1, 2006 and March 31, 2008, of 405 720 patients (69% white and 11% black; 46% Medicare patients; and 68% elective surgical cases) from 398 hospitals in the United States for whom SCIP performance was recorded and submitted for public report on the Hospital Compare Web site. Three original infection-prevention measures (S-INF-Core) and all 6 infectionprevention measures (S-INF) were aggregated into 2 separate all-or-none composite scores. Hierarchical logistical models were used to assess process-of-care relationships at the patient level while accounting for hospital characteristics. Main Outcome Measure: The ability of reported adherence to SCIP infectionprevention process-of-care measures (using the 2 composite scores of S-INF and S-INF-Core) to predict postoperative infections. Results: There were 3996 documented postoperative infections. The S-INF composite process-of-care measure predicted a decrease in postoperative infection rates from 14.2 to 6.8 per 1000 discharges (adjusted odds ratio, 0.85; 95% confidence interval, 0.76-0.95). The S-INF-Core composite process-of-care measure predicted a decrease in postoperative infection rates from 11.5 to 5.3 per 1000 discharges (adjusted odds ratio, 0.86; 95% confidence interval, 0.74-1.01), which was not a statistically significantly lower probability of infection. None of the individual SCIP measures were significantly associated with a lower probability of infection. Conclusions: Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infectionprevention score was associated with a lower probability of developing a postoperative infection. However, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was not associated with a significantly lower probability of infection.
AB - Context: The Surgical Care Improvement Project (SCIP) aims to reduce surgical infectious complication rates through measurement and reporting of 6 infectionprevention process-of-care measures. However, an association between SCIP performance and clinical outcomes has not been demonstrated. Objective: To examine the relationship between SCIP infection-prevention processof-care measures and postoperative infection rates. Design, Setting, Participants: A retrospective cohort study, using Premier Inc's Perspective Database for discharges between July 1, 2006 and March 31, 2008, of 405 720 patients (69% white and 11% black; 46% Medicare patients; and 68% elective surgical cases) from 398 hospitals in the United States for whom SCIP performance was recorded and submitted for public report on the Hospital Compare Web site. Three original infection-prevention measures (S-INF-Core) and all 6 infectionprevention measures (S-INF) were aggregated into 2 separate all-or-none composite scores. Hierarchical logistical models were used to assess process-of-care relationships at the patient level while accounting for hospital characteristics. Main Outcome Measure: The ability of reported adherence to SCIP infectionprevention process-of-care measures (using the 2 composite scores of S-INF and S-INF-Core) to predict postoperative infections. Results: There were 3996 documented postoperative infections. The S-INF composite process-of-care measure predicted a decrease in postoperative infection rates from 14.2 to 6.8 per 1000 discharges (adjusted odds ratio, 0.85; 95% confidence interval, 0.76-0.95). The S-INF-Core composite process-of-care measure predicted a decrease in postoperative infection rates from 11.5 to 5.3 per 1000 discharges (adjusted odds ratio, 0.86; 95% confidence interval, 0.74-1.01), which was not a statistically significantly lower probability of infection. None of the individual SCIP measures were significantly associated with a lower probability of infection. Conclusions: Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infectionprevention score was associated with a lower probability of developing a postoperative infection. However, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was not associated with a significantly lower probability of infection.
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U2 - 10.1001/jama.2010.841
DO - 10.1001/jama.2010.841
M3 - Article
C2 - 20571014
AN - SCOPUS:77953843154
VL - 303
SP - 2479
EP - 2485
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0098-7484
IS - 24
ER -