Year: 2016
Type: article
Abstract: quality summary scores.Thus, higher SSI scores may not truly reflect poor quality of care and may instead be indicative of the measurement bias and validity issues that have been previously suggested for other HAC program component measures. 1 There are several possible explanations.First, surveillance bias can result from variability in institutional clinical practices regarding the threshold at which potentially infected wounds are opened or cultured. 2Second, the different data collection methods used by hospitals reporting to the Centers for Disease Control and Prevention National Healthcare Safety Network may lead to hospital-level variation in event capture.Hospitals using an electronic surveillance system, which triggers review by an infection preventionist when a possible infection is detected, may uncover more events than would a manual review.These differences may be compounded by infection preventionists' variable experience, workload, and auditing practices. 3 Moreover, 38% of National Healthcare Safety Network-enrolled facilities do not have an infection preventionist, which may lead to hospital-level variation in detection. 4 Hospitals may also fail to report events in a standardized fashion with strict adherence to the abstraction guidelines. 5 Increased documentation when trainees are involved may also partly explain the higher rates of identifying events among teaching hospitals. 6 Third, although these SSI measures are risk-adjusted for limited patient and procedure characteristics, the adjustment is likely inadequate, potentially resulting in hospitals that treat sicker patients being incorrectly categorized as poor performers.Implementing more rigorous surveillance and data abstraction standards and requiring formal audit programs to ensure standardized coding may help to address some of these factors.Furthermore, changes to the measures' risk adjustment should be expanded to include hospital case mix, patient comorbidities, and other relevant procedural factors.It is possible that our findings reflect a lack of a conceptual link between Centers for Medicare and Medicaid Services' definition of high-quality care and hospital characteristics that affect performance on various measures.Still, the paradoxical relationship between SSI measure performance and hospital quality warrants reconsideration of the addition of the current SSI measures to the HAC Reduction Program in federal fiscal year 2016.
Source: JAMA Surgery
Institutions: Geisinger Medical Center, Geisinger Health System
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: American Cancer Society, California Health Care Foundation, American College of Surgeons, Northwestern University, Northwestern Memorial Foundation, National Comprehensive Cancer Network, National Institutes of Health, Agency for Healthcare Research and Quality, Robert H. Lurie Comprehensive Cancer Center, National Institute of Diabetes and Digestive and Kidney Diseases
OpenAlex ID: W2339481494