National Claims-Based Quality Measures for Surgical Site Infections

描述（由申请人提供）：医疗保健研究和质量机构（AHRQ）、疾病控制和预防中心（CDC）以及医疗保险和医疗补助服务中心（CMS）都表示有兴趣开发经验证的质量指标，用于医疗保健相关感染（包括手术部位感染（SSI））的医院间比较。AHRQ的基于索赔的质量指标已被应用于通过医疗保健成本和利用项目收集的行政数据。医疗保险已开始实施一项基于价值的采购计划，其中将包括医院使用CDC的国家医疗安全网络（NHSN）报告的深切口和器官/空间SSI。报告SSI风险较高的医院将获得较低的报销。因此，在大型手术中心和手术量较低的医院，都需要针对高风险手术进行改进的监督和有效的质量措施。与医院感染控制项目的传统SSI监测相比，索赔数据已被证明可提供更标准化和更全面的捕获。我们建议扩大我们以前的工作，使用索赔数据进行SSI监督，目标是国家规定的公开报告程序，并建议CMS进行基于价值的购买。我们将1）在冠状动脉旁路移植术（CABG）手术和髋关节置换术后扩展我们先前成功的基于索赔的监测，以识别膝关节置换术后SSI风险异常高的医院，这是另一种高容量和高成本的手术，2）识别并验证基于索赔的方法，用于估计CABG手术、髋关节置换术后深部切口和器官/间隙感染的风险，和膝关节成形术，并使用这些方法来确定医院排名的逐年预测效用，3）使用Medicare索赔与来自所有付款人索赔数据库的医院排名以及基于国家授权向NHSN报告的排名相比，评估医院SSI排名的普遍性，以及4）评估统计方法以评估低手术量医院的绩效。

DESCRIPTION (provided by applicant): The Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS) have all expressed interest in developing validated quality measures for inter-hospital comparisons of healthcare associated infections, including surgical site infections (SSIs). AHRQ's claims-based quality indicators have been applied to administrative data collected through the Healthcare Cost and Utilization Project. Medicare has begun implementation of a value-based purchasing program which will include deep incisional and organ/space SSIs reported by hospitals using the CDC's National Healthcare Safety Network (NHSN). Hospitals reporting higher SSI risks will receive lower reimbursement. Thus, there is a need for improved surveillance and validated quality measures targeting high-risk surgeries, both in major surgical centers and in hospitals with lower procedure volumes. Claims data have been shown to provide more standardized and comprehensive capture compared to traditional SSI surveillance by hospital infection control programs. We propose to expand our prior work on the use of claims data for SSI surveillance by targeting procedures mandated by states for public reporting and proposed for value-based purchasing by CMS. We will 1) extend our previously successful claims-based surveillance following coronary artery bypass graft (CABG) surgery and hip arthroplasty to identify hospitals with an unusually high risk of SSI following knee arthroplasty, another high volume and high cost procedure, 2) identify and validate claims-based methods for estimating the risk of deep incisional and organ/space infections following CABG surgery, hip arthroplasty, and knee arthroplasty, and use these methods to determine year-to-year predictive utility of hospital rankings, 3) assess the generalizability of hospital SSI rankings using Medicare claims compared to hospital rankings derived from all-payer claims databases, and from rankings based on state mandated reporting to NHSN, and 4) evaluate statistical approaches to evaluate the performance of hospitals with low procedure volumes.