Surgical Quality Measures Not Associated With Infection Rates

A study by investigators at Case Western Reserve University School of
Medicine published in the Journal of American Medical Association
found that public hospital comparison data reported by the U.S. Department of
Health and Human Services does not accurately correlate with a patient’s
risk for surgical postoperative infection. The retrospective, cohort study of
more than 400,000 patients from 398 hospitals nationwide examined the
relationship between reported adherence to six infection prevention Surgical
Care Improvement Project (SCIP) measures and the probability of patient
postoperative infection.

“The SCIP has done an outstanding job of designing and identifying
proper infection prevention measures, but there is still more work to be
done,” Jonah J. Stulberg, MD, PhD, MPH, a recent graduate of Case Western
Reserve University School of Medicine, and the lead author of the study, stated
in a press release. “Our analysis shows that using a multi-measure
approach to prevention is associated with a lower probability of patient
infection, and that is something I think everyone can appreciate.”

Due to new value-based purchasing incentives under the recently passed
Health Care Reform Act, Medicare reimbursement will be tied to hospitals’
adherence to SCIP measures. Researchers found that using a composite infection
prevention score, one that assesses more than two measures per patient visit,
was more accurate in predicting the probability of a patient developing a
postoperative infection. It predicted approximately a 15% decreased risk of
postoperative infection.

Within the current system, Medicare reports performance only on
individual SCIP measures. Stulberg and his co-authors recommend SCIP require
multiple measures be performed and recorded at every patient visit. They found
this will result in a more accurate prediction of whether a patient will
develop a postoperative infection.

“Our inability to demonstrate a statistically significant
association between individual measures and clinical outcomes at the patient
level suggests that the rates, as reported on the Hospital Compare website, do
not necessarily infer quality differences between hospitals,” Siran
Koroukian, PhD, associate professor of epidemiology and biostatistics at Case
Western Reserve University School of Medicine and senior author of the study,
said. “However, the multi-measure model in our study better captures the
culture of quality in hospitals.”

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