Use of electronic data to improve risk adjustment for hospital infection rates

描述(由申请人提供)：与医疗保健相关的感染，包括中心线相关性细菌症和手术部位感染，会增加患者的发病率和死亡率。美国大多数州都要求医院公开报告与医疗保健相关的感染率。适当的风险调整针对患者因素进行调整，而不控制护理效果的差异，使消费者和医疗保健维护组织能够被告知医疗保健的购买者。许多著名组织和作者都同意，目前医疗保健相关感染的风险调整方法是次优的。目前尚不清楚哪些患者的合并症可用于风险调整。我们的长期目标是使用电子数据来识别与医疗保健相关的感染的风险因素，以便用于准确的风险调整。这项应用的总体目标是确定哪些并存条件可用于中心线相关菌血症和手术部位感染的风险调整。我们的中心假设是，由ICD-9代码或美国各地医院很容易通过电子方式获得的入院药物识别的共病情况，可以用来更好地调整与医疗保健相关的感染率。我们计划测试我们的中心假设，从而通过追求以下两个具体目标来实现这一应用的目标：目标1.对20多家医院使用中心静脉导管的成年患者进行队列研究，以确定哪些电子获得的合并症是中心线相关性菌血症(CLABSI)的危险因素。目的2.对在20多家医院接受手术的成人患者进行一项队列研究，以确定哪些电子获得的合并症是手术部位感染的危险因素。根据Premier Inc.和马里兰大学之间的一项安排，这些网站将被按平价招募。这项协议的好处是，它将使我们能够招募大量地点，并在短时间内以具有成本效益的方式进行研究。这项拟议的工作将具有重要意义，因为它将决定是否可以使用容易获得的关于患者共病情况的电子数据来风险调整全国报告的手术部位感染率和中心线相关感染率。在我们看来，这项拟议的研究具有创新性，因为：a)它探索了患者共病情况作为风险因素和风险调整变量的使用；b)它探索了通过电子来源很容易获得的变量，使它们在国家报告中可能非常容易用于风险调整c)它使用了大量的医院。

DESCRIPTION (provided by applicant): Healthcare-associated infections including central-line associated bacteremias and surgical site infections increase patient morbidity and mortality. Most states across the United States are requiring hospitals to publicly report healthcare-associated infection rates. Proper risk adjustment adjusts for patient factors without controlling for differences in the effectiveness of care enabling consumers and healthcare maintenance organizations to be informed purchasers of healthcare. Numerous prominent organizations and authors agree that the current method of risk adjustment for healthcare-associated infections is sub-optimal. The current knowledge as to which patient comorbid conditions can be used for risk-adjustment is not known. Our long- term goal is to use electronic data to identify risk factor for healthcare-associated infections that can be used for accurate risk adjustment. The overall objective of this application is to determine which comorbid conditions can be used for risk adjustment for central-line associated bacteremia and surgical site infection. Our central hypothesis is that comorbid conditions identified by ICD-9 codes or admission medications that are easily electronically-available by hospital across the United States can be used to better risk-adjust healthcare- associated infection rates. We plan to test our central hypothesis and, thereby, accomplish the objective of this application by pursuing the following two specific aims: Aim 1. Perform a cohort study of adult patients with central venous catheters across greater than 20 hospitals to determine which electronically-obtained comorbidities are risk factors for central-line associated bacteremia (CLABSI). Aim 2. Perform a cohort study of adult patients who underwent surgery across greater than 20 hospitals to determine which electronically- obtained comorbidities are risk factors for surgical site infection. Sites will be recruited as par of an arrangement between Premier Inc. and the University of Maryland. The advantage of this agreement is that it will allow us to recruit a large number of sites and perform the study in a short time period and in a cost- effective fashion. The proposed work will be significant because it will determine whether easily-obtainable electronic data on patient comorbid conditions can be used to risk adjust nationally-reported surgical site infection rates and central-line associated infection rates. The proposed research is innovative, in our opinion, because: a) it explores the use of patient comorbid conditions as risk factors and risk adjustment variables; and b) it explores variables that are easily obtained by electronic sources, making them potentially very easy to use for risk adjustment in national reporting c) it uses a large number of hospitals.