The impact of surgical volume on hospital ranking using the standardized infection ratio.
The impact of surgical volume on hospital ranking using the standardized infection ratio.
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DOI：
10.1038/s41598-023-33937-y
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发表时间：
2023-05-10
影响因子：
4.6
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中科院分区：
文献类型：
--
作者：
医疗保险和医疗补助服务中心要求医院报告质量指标，这些指标用于对那些表现最差的医院进行经济处罚。手术部位感染（SSI）是针对医疗保健相关感染的质量指标的关键组成部分。然而，这种医院分析的准确性受到小手术量的高度影响，这导致在估计标准化的医院特异性感染率时存在大量的不确定性。目前，预期SSI少于一次的医院被排除在排名之外，但这一排除标准的有效性尚不清楚。缺乏可以量化分类准确性并可以确定所需准确性水平所需的最小手术体积的工具。我们研究了手术量对基于标准化感染率识别表现不佳的医院的准确性的影响，并开发了基于模拟的算法来量化分类准确性。我们将我们提出的方法应用于HCA Healthcare（2014-2016）关于结肠手术患者SSI的数据。我们估计，对于像结肠手术这样的手术，总体SSI率为3%，为了在HCA结肠SSI数据集中对医院进行排名，执行少于200个手术的医院被错误分配到最差四分位数的可能性超过10%。最小手术量和预测事件的标准，需要使评估医院可靠，这些标准不同的整体患病率和医院之间的变异性。
The Centers for Medicare and Medicaid Services require hospitals to report on quality metrics which are used to financially penalize those that perform in the lowest quartile. Surgical site infections (SSIs) are a critical component of the quality metrics that target healthcare-associated infections. However, the accuracy of such hospital profiling is highly affected by small surgical volumes which lead to a large amount of uncertainty in estimating standardized hospital-specific infection rates. Currently, hospitals with less than one expected SSI are excluded from rankings, but the effectiveness of this exclusion criterion is unknown. Tools that can quantify the classification accuracy and can determine the minimal surgical volume required for a desired level of accuracy are lacking. We investigate the effect of surgical volume on the accuracy of identifying poorly performing hospitals based on the standardized infection ratio and develop simulation-based algorithms for quantifying the classification accuracy. We apply our proposed method to data from HCA Healthcare (2014–2016) on SSIs in colon surgery patients. We estimate that for a procedure like colon surgery with an overall SSI rate of 3%, to rank hospitals in the HCA colon SSI dataset, hospitals that perform less than 200 procedures have a greater than 10% chance of being incorrectly assigned to the worst performing quartile. Minimum surgical volumes and predicted events criteria are required to make evaluating hospitals reliable, and these criteria vary by overall prevalence and between-hospital variability.
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影响因子：
4
作者：
Austin, Peter C.;Ceyisakar, Iris E.;Marang-van de Mheen, Perla J.
通讯作者：
Marang-van de Mheen, Perla J.
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通讯作者：
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影响因子：
2.4
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