Using Automated Health Plan Data to Assess Infection Risk from Coronary Artery Bypass Surgery

Abstract

We determined if infection indicators were sufficiently consistent across health plans to allow comparison of hospitals’ risks of infection after coronary artery bypass surgery. Three managed care organizations accounted for 90% of managed care in eastern Massachusetts, from October 1996 through March 1999. We searched automated inpatient and outpatient claims and outpatient pharmacy dispensing files for indicator codes suggestive of postoperative surgical site infection. We reviewed full text medical records of patients with indicator codes to confirm infection status. We compared the hospital-specific proportions of cases with an indicator code, adjusting for health plan, age, sex, and chronic disease score. A total of 536 (27%) of 1,953 patients had infection indicators. Infection was confirmed in 79 (53%) of 149 reviewed records with adequate documentation. The proportion of patients with an indicator of infection varied significantly (p<0.001) between hospitals (19% to 36%) and health plans (22% to 33%). The difference between hospitals persisted after adjustment for health plan and patients’ age and sex. Similar relationships were observed when postoperative antibiotic information was ignored. Automated claims and pharmacy data from different health plans can be used together to allow inexpensive, routine monitoring of indicators of postoperative infection, with the goal of identifying institutions that can be further evaluated to determine if risks for infection can be reduced.

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.…”

“…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. 11,16,20 Additional limitations include reviewing flagged records limited to the index institution where the surgery was performed and the fact that coding practices in the 4 evaluated hospitals may not be representative of other US hospitals. It will be important to assess further the performance of our more inclusive lists of SSI indicator codes on a national scale, including evaluation of claims submitted from other hospitals and practices beyond the institution where the surgery was performed.…”

“…[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.…”

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

“…28 Osteomyelitis, other specified site 730. 29 Osteomyelitis 23 and demonstrated that this methodology can be implemented by payers. 24 We now evaluate the ability of Medicare claims data to rank US hospitals by their SSI rates after CABG.…”

Adverse events associated with prolonged antibiotic use

“…The membership, demographic, pharmacy dispensing and claims files have been described elsewhere and used for other studies. 26,27 For this study, each of the nine HMORN CERT HMOs provided data for approximately representative 200,000 individuals.…”