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Use of Medicare Claims to Identify US Hospitals with a High Rate of Surgical Site Infection after Hip Arthroplasty

Published online by Cambridge University Press:  02 January 2015

Michael S. Calderwood ,
Ken Kleinman ,
Dale W. Bratzler ,
Allen Ma ,
Christina B. Bruce ,
Rebecca E. Kaganov ,
Claire Canning ,
Richard Piatt ,
Susan S. Huang  and
Centers for Disease Control and Prevention Epicenters Program and the Oklahoma Foundation for Medical Quality
Michael S. Calderwood*
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Ken Kleinman
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Dale W. Bratzler
Affiliation:
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, Oklahoma
Allen Ma
Affiliation:
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma
Christina B. Bruce
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Rebecca E. Kaganov
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Claire Canning
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Richard Piatt
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Susan S. Huang
Affiliation:
University of California Irvine School of Medicine, Irvine, California
*
Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02115 (mcalderwood@partners.org)
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Abstract

Objective.

To assess the ability of Medicare claims to identify US hospitals with high rates of surgical site infection (SSI) after hip arthroplasty.

Design.

Retrospective cohort study.

Setting.

Acute care US hospitals.

Participants.

Fee-for-service Medicare patients 65 years of age and older who underwent hip arthroplasty in US hospitals from 2005 through 2007.

Methods.

Hospital rankings were derived from claims codes suggestive of SSI, adjusted for age, sex, and comorbidities, while using generalized linear mixed models to account for hospital volume. Medical records were obtained for validation of infection on a random sample of patients from hospitals ranked in the best and worst deciles of performance. We then calculated the risk-adjusted odds of developing a chart-confirmed SSI after hip arthroplasty in hospitals ranked by claims into worst- versus best-performing deciles.

Results.

Among 524,892 eligible Medicare patients who underwent hip arthroplasty at 3,296 US hospitals, a patient who underwent surgery in a hospital ranked in the worst-performing decile based on claims-based evidence of SSI had 2.9-fold higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.2-3.7).

Conclusions.

Medicare claims successfully distinguished between hospitals with high and low SSI rates following hip arthroplasty. These claims can identify potential outlier hospitals that merit further evaluation. This strategy can also be used to validate the completeness of public reporting of SSI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 31 - 39
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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