Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection

Final Contract Report

The Agency for Healthcare Research and Quality, in cooperation with the United States Centers for Disease Control and Prevention, commissioned a study in 2009 with the objective of developing techniques to improve the identification and surveillance of likely cases of surgical site infection using data on four common procedures (hernia repair, coronary artery bypass grafts, and hip and knee arthroplasty). A major focus of the project was to test the usefulness of computer algorithms that could alert infection control specialists to patients likely to have surgical site infections on the basis of retrospective analysis of electronic medical records, laboratory test results, and patient demographics.

Prepared for the Agency for Healthcare Research and Quality under contract HHSA 290-2006-00-20.

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Prepared by Connie Savor Price, M.D. and Lucy A. Savitz, Ph.D., M.B.A.

Contents

Executive Summary
Chapter 1. Administration
Chapter 2. Determining Surgical Site Infection Rates
   Identify Potential Automated/electronic Sources of Health Care Data Useful for Surveillance of SSI
   Develop Procedure-specific Algorithms Utilizing Identified Data Sources to Detect SSI Events
   Demonstrate Performance of Electronic Detection Schemes By Comparing to an Accepted Reference Standard for SSI Surveillance
   Assess Ability of Electronic Detection Methods to Determine Procedure-specific, Organism-specific SSI Rates Versus Estimates of Annual National Burden and Identifying SSI in Health Care Facilities
   Estimate the Burdens of Electronic SSI Detection Relative to an Accepted Reference Standard
   Task 2 Discussion
Chapter 3. Design and Test Methods to Stratify Risk of SSI
   Identify Strong Predictors of SSI, Particularly Important Variables Not Currently Used in Mainstream Risk-stratification Methods
   Develop a Risk-adjustment Method That Utilizes the Identified Risk Variables to Validly Compare Rates of SSI Across Facilities
   Evaluate the Quality of the Risk-adjustment Relative to Method Complexity and the Data Collection Costs
   Identify SSI Risk Factors Using Combined Datasets From All Four Facilities/Systems
   Summary
Chapter 4. Assess Surgeon Acceptance of Risk Adjustment Models
   Study Strengths and Limitations
   Next Steps
   Examining How to Make ST-PRA More Accessible
   The List of all Resulting or Anticipated Scientific Presentations and Publications From the Project
Chapter 5. Project Expansion
  Expanding Task 2: Application of a Modified Algorithm at Denver Health
  Expanding Task 3: Testing Additional Risk Factors Using Uniquely Available Intermountain Healthcare Data
Chapter 6. Conclusions and Recommendations
  Challenges Encountered, and Strategies for Overcoming Them
  Lessons Learned and Recommendations for Next Steps
References

Appendixes
Appendix A. Teleconferences with AHRQ & CDC
Appendix B. In-Person Meetings
Appendix C. Data Dictionary
Appendix D. Mapping ICD9 and CPT Codes
Appendix E. Culture Type Map to Procedure Types
Appendix F. Algorithm
Appendix G. Pairwise Correlation of Variables with SSI and with Each Other
Appendix H. Calculating Sensitivity and Specificity for Validation
Appendix I. Initial Risk Factors
Appendix J. Additional Risk Factors
Appendix K. Final Risk Factors
Appendix L. Master Risk Factors
Appendix M. Master Risk Factor List with Final Bolded
Appendix N. Surgeon Focus Group Guide
Appendix O. Nursing Focus Group Guides
Appendix P. Focus Group Risk Factors
Appendix Q. Surgeon Focus Group Content Analysis
Appendix R. Infection Prevention Support Tool
Appendix S. Surgeons' Acceptance of Surgical Site Infection Risk Adjustment Models
Appendix T. Surgical Infection Society Abstract
Appendix U. Improving the Measurement of Surgical Site Infection (SSI) Risk Stratification and Outcome Detection ( Microsoft PowerPoint file Microsoft PowerPoint version - 394.16 KB )
Appendix V. JAMIA Draft Manuscript

Disclaimer: This document is in the public domain and may be used or reprinted without permission, except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of the copyright holders.

The opinions presented here are those of the authors and do not necessarily reflect the position of the U.S. Department of Health and Human Services or the Agency for Healthcare Research and Quality.

Current as of August 2012
Internet Citation: Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection: Final Contract Report. August 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/ssi/index.html