Hospital comparison data reported to the public by the U.S. Department of Health and Human Services does a poor job of predicting a patient’s risk for developing an infection after surgery, according to a study by investigators at Case Western Reserve University School of Medicine published in this week’s Journal of the American Medical Association.
The study suggests how the federal government could improve hospital quality reporting to the public, as well as how hospitals could minimize patient infections and maximize reimbursements from the Centers for Medicare & Medicaid Services (CMS).
The retrospective study of more than 400,000 patients from 398 hospitals nationwide examined the relationship between reported adherence to six infection-prevention Surgical Care Improvement Project (SCIP) measures and the probability of patients to develop postoperative infections, according to a school of medicine release on the study.
Hospitals tend to report adherence to only one of the SCIP measures at a time, say, the percentage of patients who received antibiotics within one hour prior to surgery, said Dr. Jonah J. Stulberg, a recent graduate of the medical school and lead author of the study.
Stulberg and his colleagues found that reporting a single measure of infection-prevention adherence did little to predict a patient’s risk of developing an infection after surgery. However, a composite infection-prevention score — one that used at least two of the measures per patient visit — predicted a 15-percent drop in postoperative infection risk.
“The SCIP has done an outstanding job of designing and identifying proper infection-prevention measures, but there is still more work to be done,” Stulberg said. “Our analysis shows that using a multi-measure approach to prevention is associated with a lower probability of patient infection, and that is something I think everyone can appreciate.”
SCIP is a national campaign and partnership of public and private healthcare organizations, including the Agency for Healthcare Research and Quality and the American Hospital Association, aimed at reducing complications from surgery, according to Premier Inc., the Charlotte, N.C. healthcare alliance that offers tools to help hospitals report data to the federal government.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Hospitals began collecting surgical data for the project in 2004, according to the Joint Commission. This data is reported to CMS and is the basis for Medicare’s Hospital Compare website at which the public can check out hospital quality.
Healthcare associated infections, including those that come from surgery, take a tremendous human and financial toll. They accounted for 1.7 million infections and 99,000 deaths in 2002, according to the Health and Human Services Department (HHS). The infections add between $28 billion and $33 billion to the nation’s healthcare costs each year.
Yet the study questions consumers’ reliance on websites like Hospital Compare to guide them to institutions that pose the least postsurgical infection risk.
“Our inability to demonstrate a statistically significant association between individual measures and clinical outcomes at the patient level suggests that the rates, as reported on the Hospital Compare website, do not necessarily infer quality differences between hospitals,” said Siran Koroukian, associate professor of epidemiology and biostatistics at Case Western Reserve University School of Medicine and senior author of the study, in the medical school’s release. “However, the multi-measure model in our study better captures the culture of quality in hospitals.”
Though SCIP prevention measures give a strong indication of postoperative infection rates, other factors such as the skill and knowledge of the surgical team may play important roles in determining these rates, said Stulberg, who soon will begin his residency in the Department of Surgery at University Hospitals Case Medical Center.
Reporting more than one SCIP measure might also help hospitals capture higher Medicare reimbursements.
In 2008, CMS started phasing in a program to reimburse hospitals based on their quality of care performance. The program, called Value-Based Purchasing, got a boost from the recently passed Patient Protection and Affordable Care Act, which strengthened the ties between hospital adherence to SCIP measures and reimbursement, according to the medical school.
