Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment
Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment
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DOI：
10.1093/cid/cix431
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发表时间：
2017-09-01
影响因子：
11.8
通讯作者：
Harris, Anthony D.
中科院分区：
文献类型：
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作者：
Jackson, Sarah S.;Leekha, Surbhi;Harris, Anthony D.
背景医疗保险和医疗补助服务中心（CMS）将手术部位感染（SSI）等医疗保健相关感染用作按绩效付费的指标。风险调整允许更公平地比较各医院的SSI率。直到2016年，疾病控制和预防中心（CDC）的按绩效付费SSI风险调整模型没有对患者合并症进行调整。新的2016年CDC模型仅调整体重指数和糖尿病。我们对28家美国医院接受外科手术的患者进行了一项多中心回顾性队列研究。获得接受结肠切除术、子宫切除术、膝关节和髋关节置换术患者的人口统计学数据和国际疾病分类第九版代码。复杂的SSI由每家医院的感染预防专家使用CDC标准确定。模型的性能进行了评价，使用的歧视和校准措施。根据SSI比例和风险调整的标准化感染比率（SIR）对医院进行排名，以评估合并症调整对公共报告的影响。在28家医院的45394例患者中，573例（1.3%）发生了复杂的SSI。包含手术类型、年龄、种族、吸烟、糖尿病、肝病、肥胖、肾衰竭和营养不良的模型显示出良好的区分度（C统计量，0.73）和校准。当按粗略比例比较医院排名与风险调整后的排名时，28家医院中有24家（86%）发生了排名变化，16家（57%）发生了>= 2级的变化，4家（14%）发生了>10级的变化。我们开发了一个性能良好的风险调整模型SSI使用电子可用的合并症。CDC和CMS应强烈考虑基于合并症的风险调整，以充分比较各医院的SSI发生率。
Background. Healthcare-associated infections such as surgical site infections (SSIs) are used by the Centers for Medicare and Medicaid Services (CMS) as pay-for-performance metrics. Risk adjustment allows a fairer comparison of SSI rates across hospitals. Until 2016, Centers for Disease Control and Prevention (CDC) risk adjustment models for pay-for-performance SSI did not adjust for patient comorbidities. New 2016 CDC models only adjust for body mass index and diabetes.Methods. We performed a multicenter retrospective cohort study of patients undergoing surgical procedures at 28 US hospitals. Demographic data and International Classification of Diseases, Ninth Revision codes were obtained on patients undergoing colectomy, hysterectomy, and knee and hip replacement procedures. Complex SSIs were identified by infection preventionists at each hospital using CDC criteria. Model performance was evaluated using measures of discrimination and calibration. Hospitals were ranked by SSI proportion and risk-adjusted standardized infection ratios (SIR) to assess the impact of comorbidity adjustment on public reporting.Results. Of 45 394 patients at 28 hospitals, 573 (1.3%) developed a complex SSI. A model containing procedure type, age, race, smoking, diabetes, liver disease, obesity, renal failure, and malnutrition showed good discrimination (C-statistic, 0.73) and calibration. When comparing hospital rankings by crude proportion to risk-adjusted ranks, 24 of 28 (86%) hospitals changed ranks, 16 (57%) changed by >= 2 ranks, and 4 (14%) changed by >10 ranks.Conclusions. We developed a well-performing risk adjustment model for SSI using electronically available comorbidities. Comorbidity-based risk adjustment should be strongly considered by the CDC and CMS to adequately compare SSI rates across hospitals.