Improving public reporting and data validation for complex surgical site infections after coronary artery bypass graft surgery and hip arthroplasty.
Improving public reporting and data validation for complex surgical site infections after coronary artery bypass graft surgery and hip arthroplasty.
复制标题
DOI：
10.1093/ofid/ofu106
复制
发表时间：
2014-12
影响因子：
4.2
通讯作者：
Huang SS
中科院分区：
文献类型：
--
作者：
Calderwood MS;Kleinman K;Murphy MV;Platt R;Huang SS
在冠状动脉搭桥手术和髋关节置换术后提交的报销索赔中的诊断代码允许标准化和有效地识别深部和器官/空间手术部位感染。深部和器官/空间手术部位感染（D/OS SSI）引起显著的发病率、死亡率和成本。费率是公开报告的，并越来越多地用作影响医院付款的质量指标。缺乏标准化的监测方法威胁到报告数据的准确性，并降低了基于这些数据进行比较的信心。我们分析了来自国家验证研究的数据，这些研究使用医疗保险索赔来触发对冠状动脉搭桥手术（CABG）和髋关节置换术后SSI确认的图表回顾。我们评估了代码性能（敏感性和阳性预测值），以选择最能识别D/OS SSI的诊断代码。分别对代码和组合代码进行分析。分析纳入143例CABG术后D/OS SSI患者和175例髋关节置换术后D/OS SSI患者。对于CABG，《9国际疾病分类第9版》（ICD-9）诊断代码识别出92%的D/OS SSI，每4例有诊断代码的病例中识别出1例D/OS SSI。对于髋关节置换术，6个ICD-9诊断代码识别了99%的D/OS SSI，每2个有诊断代码的病例中识别出1个D/OS SSI。这种识别D/OS SSI的标准化和高效方法可被医院用于改进病例发现和公开报告。该方法还可用于识别潜在的D/OS SSI病例，以便在医院审核数据验证期间进行审查。
Diagnosis codes in claims submitted for reimbursement following coronary artery bypass graft surgery and hip arthroplasty allow standardized and efficient identification of deep and organ/space surgical site infections. Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination. Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code. This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation.