Adherence to surgical care improvement project measures and the association with postoperative infections

Jonah J. Stulberg, Conor P. Delaney, Duncan V. Neuhauser, David C. Aron, Pingfu Fu, Siran M. Koroukian

Research output: Contribution to journalArticle

389 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2479-2485
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume303
Issue number24
DOIs
StatePublished - Jun 23 2010

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Adherence to surgical care improvement project measures and the association with postoperative infections'. Together they form a unique fingerprint.

Cite this