Surgical Site Infections: Volume-Outcome Relationship and Year-to-Year Stability of Performance Rankings.
Surgical Site Infections: Volume-Outcome Relationship and Year-to-Year Stability of Performance Rankings.
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DOI：
10.1097/mlr.0000000000000620
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发表时间：
2017-01
期刊：
影响因子：
3
通讯作者：
Platt R
中科院分区：
文献类型：
--
作者：
Calderwood MS;Kleinman K;Huang SS;Murphy MV;Yokoe DS;Platt R
补充数字内容可在正文中找到。手术部位感染率(SSI)被公开报告为质量指标，并越来越多地被用于确定财务报销。评估冠状动脉旁路移植术(CABG)和髋关节置换术后的容量-结果关系以及性能排名的年度稳定性。我们对2005年至2011年在美国医院接受CABG手术或髋关节置换术的医疗保险受益人进行了一项回顾性队列研究，分析了截至2012年3月的结果。国家确认的基于索赔的监测方法被用于在手术后90天内评估SSI。采用Logistic回归和广义加性模型分析手术总量与SSI发生率之间的关系。使用Logistic回归评估SSI比率的年度稳定性，以评估医院在与经济处罚相关的绩效排名中的移动和移出。基于索赔的病例组合调整的SSI风险在每年进行50个冠脉搭桥术和200个髋关节置换术的医院中最高，而在进行≥200个手术/年的医院中是最高的。与此同时，根据申领人数，处于给定年份最差四分位数的医院第二年保持在该四分位数的可能性很低。当使用2年的经验时，这种概率随着容量的增加而增加，但CABG的最高概率仅为0.59(95%可信区间，0.52-0.66)，髋关节置换的最高概率仅为0.48(95%可信区间，0.42-0.55)。年程序量低的医院的SSI总风险最高，但这些医院目前被排除在质量报告之外。即使对于容量较大的医院，每年的随机变化也使过去的经验不能可靠地估计当前的业绩。
Supplemental Digital Content is available in the text. Surgical site infection (SSI) rates are publicly reported as quality metrics and increasingly used to determine financial reimbursement. To evaluate the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. We performed a retrospective cohort study of Medicare beneficiaries who underwent CABG surgery or hip arthroplasty at US hospitals from 2005 to 2011, with outcomes analyzed through March 2012. Nationally validated claims-based surveillance methods were used to assess for SSI within 90 days of surgery. The relationship between procedure volume and SSI rate was assessed using logistic regression and generalized additive modeling. Year-to-year stability of SSI rates was evaluated using logistic regression to assess hospitals’ movement in and out of performance rankings linked to financial penalties. Case-mix adjusted SSI risk based on claims was highest in hospitals performing <50 CABG/year and <200 hip arthroplasty/year compared with hospitals performing ≥200 procedures/year. At that same time, hospitals in the worst quartile in a given year based on claims had a low probability of remaining in that quartile the following year. This probability increased with volume, and when using 2 years’ experience, but the highest probabilities were only 0.59 for CABG (95% confidence interval, 0.52–0.66) and 0.48 for hip arthroplasty (95% confidence interval, 0.42–0.55). Aggregate SSI risk is highest in hospitals with low annual procedure volumes, yet these hospitals are currently excluded from quality reporting. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance.