Use of Medicare Claims to Rank Hospitals by Surgical Site Infection Risk following Coronary Artery Bypass Graft Surgery

Abstract

"Use of Medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery. " Infection Control and Hospital Epidemiology.32,8. 775-783. (2011).

Use of Medicare Diagnosis and Procedure Codes to Improve Detection of Surgical Site Infections following Hip Arthroplasty, Knee Arthroplasty, and Vascular Surgery

“…16,17,20 Similar work has demonstrated the usefulness of this surveillance method for detecting SSI following CABG. 11,12 It is important to note, however, the limitations of this study, which include the use of claims from a single payer. While only half of patients undergoing these procedures are insured by Medicare, 20,21 claims-based approaches to SSI surveillance have been shown to work well when applied across payers in individual hospital settings.…”

“…Nevertheless, we do note that our prior work on post-CABG SSIs showed a similar positive predictive value in our pilot study in these same hospitals as it did on the national scale. 12 Finally, the utility of this method is reliant on the speed at which codes are available at both the hospital and national level; however, the required surveillance period for surgical procedures that include prosthetic material includes 365 days postoperatively, allowing ample time for coding, particularly since the majority of SSI occur in the first 90 days. 14 In summary, use of diagnosis and procedure codes to identify charts for review provides an efficient, labor-saving, and improved method for primary SSI surveillance.…”

“…[5][6][7][8][9][10] These demonstrations of increased detection include the use of Medicare claims data to identify SSI following coronary artery bypass graft (CABG) surgery. 11,12 We explored the potential usefulness of coded diagnoses and procedures captured in claims as the primary trigger for chart review aimed at identifying SSIs after hip arthroplasty, knee arthroplasty, and vascular surgery. These are 3 of the 7 high-volume procedures targeted by the Surgical Care Improvement Project (SCIP), a national partnership of public and private organizations focused on the reduction of surgical complications.…”

Medicare Claims Can Be Used to Identify US Hospitals With Higher Rates of Surgical Site Infection Following Vascular Surgery

“…25,27 The rankings were derived from a generalized linear mixed model, 31 with risk adjustment for patients' age, sex, and coded Romano comorbidities for a Medicare population shown to be predictive of SSI in prior work. 25,27,32,33 The rankings used empirical Bayes estimators (predicted random effects), which drew hospitals with low procedure volume toward the mean, due to their greater variability. [34][35][36] On the basis of the risk-adjusted rankings, hospitals were grouped into deciles.…”

“…5,6,[22][23][24][25][26][27][28][29][30] This strategy is being used by hospitals and state SSI programs to improve reporting, 26,29,30 and by CMS during validation survey.…”