Appendix A. Teleconferences with AHRQ & CDC

Improving the Measurement of Surgical Site Infection (SSI) Risk Stratification and Outcome Detection

Monthly Teleconference
Tuesday, 17 November 2009; 12:00 MST

Participants: CDC Technical advisors: Sandra Barrios, Teresa Horan, Jonathan Edwards Project Team: Lucy Savitz, Connie Price, Mike Rubin, Makoto Jones, Jason Scott, Susan Moore

The focus of this call was to review our progress report and to review the final work plan. A summary of points covered is reviewed below.

  • Progress Report
    • Task 4
      • OMB clearance not needed for focus groups.
      • Identified target meeting for focus group at the Academic Surgical Congress in February 2010.
    • Task 2
      • Mapping ICD-9 codes to CPT codes—Mike and Makoto are continuing to work on the mapping
        • CDC would like to see the mapping when available.
    • Task 1
      • Monthly conference calls are set-up for the third Tuesday of every month at 12:00 MST (Next call 15 December).
      • First face-to-face meeting is scheduled for Friday, 20 November at IH.
      • Subcontracts with organizations are progressing.
  • Work Plan
    • Resolution matrix was included in the updated work plan to clearly specify how the research team addressed the comments and recommendations from the CDC technical experts and AHRQ TOO.
    • Connie Price explained the rationale for covering herniorrhaphy (HER) over colon surgery because HER is more elective and allows for more pre-op opportunity to modify SSI risk; and many states, including Colorado, are reporting SSI cases for herniorrhaphy; further, it allows us to examine a relatively common and often outpatient surgery.
    • Sandra Barrios questioned the timing of the focus groups and validating the risk factors.
      • Lucy will revise the work plan to clarify the timing and relationship of the tasks.

Next meeting: 15 December 2009, 12:00 MST

Monthly Teleconference
Tuesday, 15 December 2009; 12:00 MST

  • Clarification of the list of risk factors
    • The list should include all risk factors—modifiable and non-modifiable

Overall Project Status update

  • Task 2
    • Review of ICD-9 and CPT codes to complete mapping.
    • In the process of forming a data dictionary.
    • Working with Scott Evans to identify data elements from IH algorithm.
    • SLCVAH has received approval from the VA security officer to participate as planned.
  • Task 3
    • A timeline is being created and reviewed to facilitate the steps necessary leading-up to the focus groups.
    • In review of the initial list of risk facts from Walt Biffl, Scott Evans has added an "EMR" column to indicate of it is currently available in the EMR; and he has added a �Define� column to indicate the need to clarify the definition of the risk factor.
    • Literature search from 2008 - current was conducted-
      • PubMed keyword search: "SSI risk factors"
    • Scott is compiling a list of additional risk factors based on a review of abstracts defining and listing SSI risk factors.
  • Task 4
    • Walt Biffl is planning the focus group to include 10-12 surgeons at the Academic Surgical Congress, in February.
      • The focus group will review current accepted risk stratification models and review the list of new risk factors.
      • The group will evaluation additional risk factors not in the list and provide feedback relevant to the factors being modifiable vs. non- modifiable.
  • Task 1/5
    • During the meeting at IH, the group review and coordinated the responsibilities across the organizations.

Action item

The CDC/AHRQ team requested a contact list of individuals involved in the project.

  • Susan and Jason will coordinate and distribute the complete list to the CDC/AHRQ team.

Monthly Teleconference
Tuesday, 19 January 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introductions

Overall Project Status update

  • Task 2
    • Review of the algorithm prototype and data dictionary.
  • Task 3
    • The list of identified risk factors is being reviewed and will begin review by each organization to determine availability in EMR.
  • Task 4
    • A room for the focus group has been reserved and 4 participants are currently confirmed.
    • Susan and Lucy are preparing a guide for the focus group.
  • Task 1/5 - Administrative

Other items?

Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST
*agenda and any reference materials will be sent on 12 February 2010 due to Presidents� Day holiday on 15 February 2010

Monthly Teleconference
Tuesday, 19 January 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Participants: AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Teresa Horan
Project Team: Lucy Savitz, Connie Price, Mike Rubin, Makoto Jones, Jason Scott, Susan Moore, Scott Evans, Russ Staheli

Overall Project Status update

  • Task 2
    • Makoto reviewed the algorithm prototype and data dictionary
      • The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.
        • The plan is to progress with the current algorithm for a test set then review the gaps and look at other work to pick-up any events initially missed.
  • Task 3
    • The list of identified risk factors is to include all factors-including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR
      • Each organization is beginning review of the list of risk factors and will have EMR availability results to the group by 5 February 2010.
  • Task 4
    • A room for the focus group has been reserved and 4 participants are currently confirmed
      • The CDC/AHRQ team requested a list of specialties of the focus group participants
        • Once all participants for the focus group have been confirmed, Susan will compile and submit this information.
      • Susan and Lucy are preparing a guide for the focus group.
      • A focus group of OR nurses is being planned at Intermountain Healthcare.
      • Plan is submitted for expedited IRB review.
  • Task 1/5 � Administrative
    • Subcontract between Denver Health and SLCVAH is complete.
    • Subcontract between Denver Health and Intermountain Healthcare is near complete.
    • Intermountain Healthcare is working to get Privacy Board approval for use of de-identified data.
    • SLCVAH has received Privacy Board approval for use of de-identified data.

Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST
*agenda and any reference materials will be sent on 12 February 2010 due to Presidents� Day holiday on 15 February 2010

Monthly Teleconference
Tuesday, 16 March 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 2
    • Review of updated algorithm and process to begin testing.
  • Task 3
    • Progress update of risk factor organization review.
  • Task 4
    • Follow-up discussion of focus group.
    • Focus group summary.
  • Task 1/5
    • Administrative.

Additional items, questions/concerns, or comments.

Next call:
20 April, 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 April 2010

Monthly Teleconference
Tuesday, 16 March 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Sandra Barrios
Project Team: Lucy Savitz, Susan Moore, Mike Rubin, Walt Biffl, Scott Evans, Jason Scott

Overall Project Status update

  • Task 2
    • Review of updated algorithm and process to begin testing
      • Data collection phase will begin at Salt Lake City VA and Intermountain Healthcare immediately following IRB approval.
        • NSQIP data will be used initially to train the algorithm and test availability.
        • Following initial training and testing at Salt Lake City VA and Intermountain Healthcare, the algorithm is expected to undergo adjustments based on data results before system wide testing.
  • Task 3
    • Progress update of risk factor organization review
      • The list of common risk factors and availability is near complete and will be distributed immediately following completion.
  • Task 4
    • Follow-up discussion of focus group
    • Focus group summary
      • The draft Provisional Content Analysis of the focus group was reviewed.
        • Although the inclusion of nonmodifiable factors was considered "inappropriate" by the focus group, nonmodifiable factors will be included for testing.
          • The concern of nonmodifiable factors is a point of comment, not exclusion.
        • The ranking of risk factors includes "Feasible" criteria, which indicates the ability to access the data electronically; while "Feasible, Difficult" would require manual review to obtain the data.
          • The lower ranking factors are not criteria for exclusion from testing. All identified risk factors will be tested in the algorithm.
        • Based on preliminary review, Sandra indicated no apparent omission from the list of risk factors
          • Sandra will review the list with Teresa and Jonathan and communicate any concerns to the group.
  • Task 1/5
    • Administrative
      • All sub contracts are complete.

______________________________

Next call:
20 April, 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 April 2010

Monthly Teleconference
Tuesday, 20 April 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 2
    • Review of process to begin algorithm testing and training.
  • Task 3
    • Review if master risk factor list.
    • Review of process for writing program to collect and pool data.
  • Task 4
    • Focus group content analysis update.
  • Task 1/5
    • Administrative.

Additional items, questions/concerns, or comments.

Next call:
18 May 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 May 2010

Monthly Teleconference
Tuesday, 20 April 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Jonathan Edwards, Teresa Horan
Project Team: Susan Moore, Mike Rubin, Scott Evans, Connie Price, Jason Scott

Overall Project Status update

  • Task 2
    • Review of process to begin algorithm testing and training
      • Collecting VA data (NSQIP) will begin data collection with IH immediately following IRB approval from IH.
  • Task 3
    • Review if master risk factor list
      • Master risk factor list is complete.
      • All variables identified as "depends on definition" are being defined by ICD-9 definitions.
    • Review of process for writing program to collect and pool data
      • Meeting with Risk Adjustment Group is being planned for May 18
        • Will develop spreadsheet for each site to use.
          • Make sure to differentiate between not knowing, and not having the factors available ("0")
        • Request to include Jonathan in the Risk adjustment Group meeting via telephone for the May 18 meeting
          • Jason will send meeting information/call-in information to Jonathan.
  • Task 4
    • Focus group content analysis update.
      • Finishing content analysis.
  • Task 1/5
    • Administrative
      • Subcontracts are finalized.
      • Billing process for IH and SLCVA are in progress.

Next call:
18 May 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 May 2010

Monthly Teleconference
Tuesday, 18 May 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 2
    • Review of algorithm testing and training
  • Task 3
    • Review and update of master risk factor list.
    • Review of program development to collect and pool data.
    • Risk adjustment meeting
      • Today; 15:00 (Eastern), 13:00 (Mountain).
  • Task 4
    • Focus group content analysis update.
  • Task 1/5
    • Administrative.

Additional items, questions/concerns, or comments.

Next call:
15 June 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 11 June 2010

Monthly Teleconference
Tuesday, 18 May 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees: AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Jonathan Edwards, Teresa Horan
Project Team: Lucy Savitz, Walt Biffl, Susan Moore, Mike Rubin, Scott Evans, Connie Price, Jason Scott

Overall Project Status update

  • Task 2
    • Review of algorithm testing and training.
  • Task 3
    • Review and update of master risk factor list
      • Coding for procedures
        • ICD-9:
          • for each admit—store primary code.
          • Use of decimals in the code?
            • Decimals should be included
              • Each organization will verify use of decimals in EMR
        • Duration of Surgery factor is measured in minutes from incision to closure.
    • Review of program development to collect and pool data
      • Scott is working on a common spreadsheet template for each organization to record the data
        • Each row of the spreadsheet will record a separate surgery.
      • Each organization will look at the common risk factors.
        • There will also be a sub analysis of all the risk factors available at Intermountain Healthcare.
        • Kendall requested a list of variables unique to each organization.
    • Risk adjustment meeting
      • Today; 15:00 (Eastern), 13:00 (Mountain)
  • Task 4
    • Focus group content analysis update
      • Susan and Walt have finished review of provisional analysis
        • No follow-up items determined.
        • Final review will be available at next meeting.

Action Items:

  • Complete list of all variables unique to each organization.

Next call:
15 June 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 11 June 2010

Monthly Teleconference
Tuesday, 15 June 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 3
    • Review risk adjustment meeting
    • Updated master risk factor list
  • Task 4
    • Meeting held to review final themes of surgeon focus group
  • Task 1/5
    • Administrative

Additional items, questions/concerns, or comments.

Next call:
20 July 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 July 2010

Monthly Teleconference
Tuesday, 15 June 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Jonathan Edwards
Project Team: Susan Moore, Mike Rubin, Scott Evans, Connie Price, Jason Scott

Introduction

Overall Project Status update

  • Task 3
    • Review risk adjustment meeting
      • Handling of missing variables
        • Once frequencies are available the need to impute values will be determined.
      • Multiple procedures for the same patient will be included
    • Updated master risk factor list
      • Anemia
        • The inclusion of the measured value of hemoglobin will be more useful than a yes/no value of anemia
          • yes/no anemia values can be derived from the measured values based on set criteria to be used in the analyses of SSI risk factors.
        • Check with Walt regarding the inclusion of preop and postop hemoglobin levels.
      • DVT
        • Measure of DVT can determine the use of anticoagulants which contributes to the risk of hematoma.
        • Check with Walt regarding the inclusion of DVT as a measure of SSI risk factors.
      • Antibiotics
        • Measure of antibiotic use should be broken into two factors
          • Preop antibiotic use
          • Preop antibiotic DC timing
            • Cardiac surgeries have DC time of 48 hrs.
            • All other surgeries have DC time of 24 hrs.
  • Task 4
    • Meeting held to review final themes of surgeon focus group
      • The final content analysis is being completed and will be available before the next call.
  • Task 1/5
    • Administrative
      • IRB & Privacy Board review are continuing at Intermountain and Denver.

Additional items, questions/concerns, or comments.

Next call:
20 July 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 July 2010

Monthly Teleconference
Tuesday, 20 July 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 3
    • Review of data collection process for common risk factors.
    • Outstanding items discussion.
  • Task 4
    • Final content analysis of surgeon focus group
  • Task 1/5
    • Administrative

Additional items, questions/concerns, or comments.

Next call:
17 August 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 13 August 2010

Monthly Teleconference
Tuesday, 20 July 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Teresa Horan
Project Team: Susan Moore, Lucy Savitz, Scott Evans, Connie Price, Jason Scott

Introduction

Overall Project Status update

  • Task 2
    • Gold standard question
      • Testing the electronic algorithm against the NSQIP dataset.
        • The rigor of the surveillance with NSQIP is more complete than the collection at most sites.
          • Tested at SLCVAMC and Intermountain
            • Intermountain only collects on one procedure
      • Options
        • Use national VA data
          • Not diverse population
          • Difficult to get permission to use national data
        • Use of VA NSQIP and IH data
      • Any concerns with using IP collected data
        • If the algorithm is being designed to replace the typical IP system, it should be to base it off of typical IP collection.
        • It can be validated against the different systems and verify against NSQIP (SLCVAMC) and Intermountain.
      • Subset analysis of perioperative deep wound/organ space infections
  • Task 3
    • Review of data collection process for common risk factors
      • IH has reviewed all common risk factors and identified several elements that could be problematic to collect reliably.
        • IH has completed provisional analyses of ~ 20,000 patients
      • Denver has begun collection of data and will report with any trouble elements.
    • Outstanding items discussion
      • Postop hemoglobin has been added to the risk factor list
      • Abx dx - 48 for CABG, and 24 for all others
        • need to add into risk factors table
      • Hypocholesterolemia "TYPO? Instead of Hyper?"
        • Hypocholesterolemia was determined as a risk factor by the surgeon focus group as an indication of poor wound healing
      • Anemia-follow-up on collection of value-the collection of the value is possible instead of just a yes/no.
  • Task 4
    • Final content analysis of surgeon focus group
      • The usefulness of the focus group outcomes:
        • The process of the focus group can be considered and discussed in the final report
          • Validity check
          • Engaging the surgeon group
          • Capturing factors the team may not have considered.
  • Task 1/5
    • Administrative
      • IRB & Privacy Board approval pending at Denver and Intermountain

Additional items, questions/concerns, or comments.

Next call:
17 August 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 13 August 2010
--There may be a potential conflict with this call.
Sandra and Teresa will check their schedules and contact Susan to reschedule if necessary

Monthly Teleconference
Tuesday, 21 September 2010 - 13:00 EST; 11:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 2
    • Salt Lake City VA has the data to begin creating the rules for the algorithm.
  • Task 3
    • Data collection is taking place within each organization
  • Task 4
  • Task 1/5
    • In-person team meeting scheduled
      • 15 October 2010 in Salt Lake City
        • Project officer invite to participate via videoconference.

Additional items, questions/concerns, or comments.

Next call:
17 August 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 13 August 2010

Monthly Teleconference
Tuesday, 21 September 2010 - 13:00 EST; 11:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Teresa Horan
Project Team: Lucy Savitz, Susan Moore, Scott Evans, Jef Huntington, Makoto Jones, Pat Nechodom, Jason Scott

Introduction

Overall Project Status update

  • Task 2
    • Salt Lake City VA has the data to begin creating the rules for the algorithm.
      • NSQIP data will be used to train the algorithm with older data and tested with newer data
      • IRB has been approved for expanded VA data
    • Task 2 team meeting is scheduled for October 4th.
  • Task 3
    • Data collection is taking place within each organization
      • All variables have been finalized
      • Intermountain has collected data and is preparing for analysis
      • All organizations are in the process of collecting data
        • Collected data will be sent to Jeff Huntington at Intermountain
        • Susan will follow up with Connie to get data collection progress from Vail.
  • Task 1/5
    • In-person team meeting scheduled
      • 15 October 2010 in Salt Lake City
        • Project officer and technical advisors are invited to participate via videoconference or telephone from 3:00 - 4:00 PM EST
          • Susan will send invitations to the project officer and technical advisors for participation mode (video or telephone).

Next call:
19 October 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 18 October 2010

Monthly Teleconference
Tuesday, 30 November 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 2
    • NSQIP data collection at Salt Lake City VA Medical Center-including national VA NSQIP data
  • Task 3
    • Program development and data analysis at Intermountain
    • Data collection at other systems
    • Development of table to indicate where each system had the data for each risk factor.
  • Task 4
    • Repurposed nursing focus group to present use cases for response.
      • Denver (Mile High APIC)
      • Salt Lake City
  • Task 1/5
    • Final in-person team meeting scheduled for 28 January 2011 in Vail, Colorado

Additional items, questions/concerns, or comments.

Next call:
21 December 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 17 December 2010

Monthly Teleconference
Tuesday, 30 November 2010 - 14:00 EST; 12:00 MST
Call-in number: 866-266-7337; code: 489038#

Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Teresa Horan, Sandra Barrios, Jonathan Edwards
Project Team: Lucy Savitz, Susan Moore, Connie Price, Heather Gilmartin, Jef Huntington, Makoto Jones, Jason Scott

Introduction

Overall Project Status update

  • Task 2
    • NSQIP data collection at Salt Lake City VA Medical Center-including national VA NSQIP data
      • All data (local and national VA NSQIP) has been collected
      • Analysis has begun
        • There are some discrepancies with the start dates of the data
          • SLC VA is working to clean the data
        • Algorithm is in the development process
        • National projection
          • Numbers are small with about 20 total outcomes from documented SSI events
          • There was a discussion of strength of national projections based on the population mix of the VA data as well as the small numbers
            • The measures will be validated using SLC VA data as well as Intermountain data from all hospitals
            • The projections, with validation, are expected to accurately represent regional projections, and with the inclusion of national VA data have national validity
  • Task 3
    • Data collection at other systems
      • Denver Health is completing the data collection
        • There are a few elements that have been difficult to collect, and a meeting is set up within Denver Health to complete the collection of the remaining elements
      • Vail has begun collection and will complete the pull following the collection at Denver Health and Intermountain
      • SLC VA has pulled all data elements
  • Task 4
    • Repurposed nursing focus group to present use cases for response to be held at Denver (Mile High APIC) and Salt Lake City.
      • 1st draft of focus group protocol is complete and will be included in the December report
        • A meeting with Intermountain and Denver Health is planned to review the draft.
      • The focus group dates have not yet been set
        • The results of the data analyses of the project are expected to be presented at the focus groups
          • Once data analysis is complete, focus group dates will be set�likely in February.
      • An abstract has been submitted to SHEA
        • The abstract will be sent the AHRQ & CDC in the next monthly report.
        • No cost extension is likely denied
          • Meeting attendance as a part of dissemination may not be possible as part of the project.
        • Susan will inquire about the possibility of registering for conferences prior to the end of the contract.
  • Task 1/5
    • Final in-person team meeting scheduled for 28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
      • Draft final report will be submitted by 15 February 2011.
      • Final report will be submitted 11 March 2011.
  • Next call: 21 December 2010; 14:00 EST; 12:00 MST
    *agenda and reference materials will be sent on 17 December 2010
    • The call may have to be rescheduled based on availability of the group.

More information to come.

Monthly Teleconference
Tuesday, 28 December 2010 - 14:00 EST; 12:00 MST
Call-in number: 866-266-7337; code: 134690#

Proposed Agenda

Introduction

Overall Project Status update

  • Task 2
    • National VA NSQIP data analysis.
    • Algorithm development.
  • Task 3
    • Program development and data analysis at Intermountain.
    • Development of table to indicate where each system had the data for each risk factor.
  • Task 4
    • Repurposed nursing focus group to present use cases for response.
      • First focus group will assess and develop workflow of current SSI surveillance and the resources for process change implementation
      • Second focus group will assess workflow from first group and address the resources and workflow for process change implementation.
      • Both focus groups are planned to be held in January
        • Denver (Mile High APIC)
        • Salt Lake City
    • Updates on conference presentations
  • Task 1/5
    • Final in-person team meeting scheduled for 27-28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
      • Draft final report will be submitted to AHRQ by 11 February 2011
      • Final report will be submitted to AHRQ 11 March 2011

Additional items, questions/concerns, or comments.

Next call:
18 January 2011; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 January 2011

Monthly Teleconference
Tuesday, 28 December 2010 - 14:00 EST; 12:00 MST
Call-in number: 866-266-7337; code: 134690#

Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Teresa Horan, Sandra Barrios
Project Team: Lucy Savitz, Susan Moore, Connie Price, Heather Gilmartin, Mike Rubin, Jason Scott

Introduction

Overall Project Status update

  • Task 2
    • National VA NSQIP data analysis complete
      • Mike will send the results of the analysis to Susan to distribute.
    • Algorithm development
      • Currently working to get the data into a usable format for the algorithm
  • Task 3
    • Program development and data analysis at Intermountain
      • The program is being developed using Intermountain and Denver Health data
      • The program will be updated as data from other sites come in
        • Vail is expecting to have data available early January
        • SLC VA is working to finish collection
    • Development of table to indicate where each system had the data for each risk factor.
      • The process of data collection is being carefully documented to identify data sources as well as the decision making process to use one data source over another
    • There have been no surprises from the data collection process except for the varied sources of data—which, as indicated, are being thoroughly documented.
  • Task 4
    • Repurposed nursing focus group to present use cases for response.
      • First focus group will assess and develop workflow of current SSI surveillance and the resources for process change implementation
        • A mockup flowchart will be presented for the group to respond to.
      • Second focus group will assess workflow from first group and address the resources and workflow for process change implementation.
      • Both focus groups are planned to be held in January
        • Denver (Mile High APIC)
        • Salt Lake City
      • Generalizability of results
        • The focus groups are expected to have representation from at least 6 different systems
        • The groups will be looking at the process of an electronic surveillance tool
        • The focus groups are expected to raise some interesting and useful questions about the adoption and use of the surveillance tool as well as process challenges
    • Updates on conference presentations
      • SHEA abstract was accepted
      • Abstract submitted to SIS
      • Susan will send both abstracts to AHRQ & CDC
  • Task 1/5
    • The request has been submitted to the contracting officer to pay for dissemination including all costs associated with conference registrations, travel to conferences, journal submissions (e-journal: Implementation Science)
      • The request was made to pay for such dissemination efforts prior to the end of the contract period.
    • Final in-person team meeting scheduled for 27-28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
      • Jonathan expressed interest in attending the meeting
        • Susan will look into reserving a room at the hotel for him and confirm with him in early January
    • Draft final report will be submitted to AHRQ by 11 February 2011
      • The report has been outlined and sections have been assigned.
      • Sections will be completed mid-January
      • The sections will be integrated to be worked on at the January 27-28 meeting
      • A �Lessons Learned� section will be included in the report
    • Final report will be submitted to AHRQ 11 March 2011

Next call:
18 January 2011; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 January 2011

Monthly Teleconference
Tuesday, 19 January 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Participants:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Teresa Horan
Project Team: Lucy Savitz, Connie Price, Mike Rubin, Makoto Jones, Jason Scott, Susan Moore, Scott Evans, Russ Staheli

Overall Project Status update

  • Task 2
    • Makoto reviewed the algorithm prototype and data dictionary
      • The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.
        • The plan is to progress with the current algorithm for a test set then review the gaps and look at other work to pick-up any events initially missed.
  • Task 3
    • The list of identified risk factors is to include all factors—including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR
      • Each organization is beginning review of the list of risk factors and will have EMR availability results to the group by 5 February 2010.
  • Task 4
    • A room for the focus group has been reserved and 4 participants are currently confirmed
      • The CDC/AHRQ team requested a list of specialties of the focus group participants
        • Once all participants for the focus group have been confirmed, Susan will compile and submit this information.
      • Susan and Lucy are preparing a guide for the focus group
      • A focus group of OR nurses is being planned at Intermountain Healthcare
      • Plan is submitted for expedited IRB review
  • Task 1/5 - Administrative
    • Subcontract between Denver Health and SLCVAH is complete.
    • Subcontract between Denver Health and Intermountain Healthcare is near complete.
    • Intermountain Healthcare is working to get Privacy Board approval for use of de-identified data.
    • SLCVAH has received Privacy Board approval for use of de-identified data.

Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST
*agenda and any reference materials will be sent on 12 February 2010 due to Presidents' Day holiday on 15 February 2010

Monthly Teleconference
Monday, 31 January 2011 - 10:00 EST; 8:00 MST
Call-in number: 888-342-6631; code: 2414#

Meeting Notes

Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Sandra Barrios
Project Team: Lucy Savitz, Susan Moore, Scott Evans, Connie Price, Mike Rubin, Makoto Jones, Jef Huntington, Jason Scott

Overall Project Status update

  • Task 2
    • Algorithm training
      • National VA NSQIP data is being used to identify the small set of electronically available variables that contribute most to the detection of SSI using recursive partitioning.
        • A hybrid system is planned�to use the algorithm as a surveillance tool to trigger reduced burden of manual review by ICPs
        • Deep tissue & organ space surveillance vs inclusion of superficial infections
          • It was proposed to focus the algorithm on deep tissue and organ space infection to increase the sensitivity and minimize false positives of the surveillance tool.
          • The algorithm is still expected to pick up some superficial infections, but the tool would be honed to pick up the more clinically relevant complex infections.
          • Sandra asked if CABG is divided into sternal and harvest subgroups as superficial infections are more common in harvest procedures.
          • The data will be evaluated to look at sternal vs harvest CABG.
        • Sandra asked if burden estimates can be evaluated to look at the algorithm with all SSI inclusions vs just complex
          • We need to document what is lost by tuning the algorithm to deep wound and organ space infections
          • Estimates will be evaluated and included in the final report.
        • Kendall asked for a flowchart of the algorithm
          • Mike and Makoto will provide the flowchart, which is generated via the classification tree, and these will be included in the final report as an appendix
      • Determination of burden to implement the algorithm at different sites
        • Each site is documenting the set up and implementation process costs.
        • We expect these to be minimal.
  • Task 3
    • The data from all systems is being incorporated and used to identify key risk factors.
  • Task 4
    • Repurposed nursing focus group to present use cases for response.
      • Focus groups have been exempted by the Intermountain IRB and from OMB clearance review (as the two nursing focus group protocols are distinct and in compliance with OMB rules).
        • Denver—Wednesday, 2 February 2011
          • Getting ICPs from at least 4 systems in the area to explore issues around adoption of the surveillance tool
        • Salt Lake City--TBD
          • ICPs for multiple systems will explore issues around implementation of the surveillance tool
        • Lucy is working to recruit participants for the 2nd focus group, which is intended to iteratively follow focus group 1 (results from group 1 inform discussion in group 2)
      • The outputs of the focus groups will be used to create a user manual and include at least 2 use cases.
  • Task 5
    • Draft final report will be delivered electronically by 11 February 2011
      • The report will be in Word format and the appendices will be PDFs
      • The draft report will also be submitted through ARRS
    • Updates on conference presentations/dissemination.
      • Kendall submitted a dissemination plan to include attendance and presentation at SHEA, SIS, Academy Health, and the AHRQ Annual Meeting. Publications were also included in the plan.
    • Discussion of sustained tool implementation and development
      • Sandra discussed the importance of making sure the tool is viewed by adopting systems to be dynamic (vs. static)) continually evolving and will QI/QA with continuing feedback to support improvement and continued applicability of the tool.
      • Kendall asked how we plan to keep a feedback loop.
        • Feedback recommendations will be made in the report
        • Denver Health is planning to use the tool and modify it to include other surgeries.
        • Adoption at SLC VAMC would likely show applicability in VAs nationwide�Mike will explore a connection with the VA National Center for Patient Safety as suggested by Kendalll
        • Lucy will connect with the AHRQ Health Care Innovations Exchange to explore how we might monitor and track uptake.
  • Task 1
    • The call scheduled on 15 February 2011 was proposed to be postponed one week to allow time for AHRQ & CDC to provide feedback from the draft report
      • Susan will poll the group to reschedule the call
    • Invoicing
      • Systems are working with their accounting departments for updated invoices and final invoicing to be submitted on time.

Next call: To be determined, on or about 2/22/11. Susan will get dates and times to reschedule

Monthly Teleconference
Tuesday 15 March 2011 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees:
AHRQ: Kendall Hall
CDC: Teresa Horan, Sandra Barrios Jonathan Edwards
Project Team: Susan Moore, Lucy Savitz, Jason Scott, Jef Huntington, Mike Rubin, Makoto Jones, Connie Price, Walt Biffl, Heather Gilmartin

  • General project updates
    • No cost extension granted through October 2011 for dissemination
      • Project work planed to be finished in April
    • The algorithm is being run at each site multiple times
      • Specificity is very low (many false negatives)
      • Doing extensive chart reviews to learn more about the e surveillance
        • Looking for elements that were not picked-up, but present in charts (specifically false negatives)
        • Determine factors leading to false negatives
    • Task three work is continuing and will use additional time for QA of code
    • Task 4: focus groups complete.
      • Generating a universal user manual
  • Dissemination plans
    • AMIA-abstract due 17 February
    • What should be submitted to AHRQ and CDC prior to dissemination?
      • AHRQ and CDC would like to review abstracts for dissemination activities
  • Additional items
    • Connie and Jonathan with arrange time at the SHEA meeting to have a group discussion
      • Will include a detailed review of the algorithm development process.

Monthly Teleconference
Tuesday 19 April 2011 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#

Notes

Attendees:
AHRQ: Kendall Hall
CDC: Teresa Horan, Jonathan Edwards
Project Team: Susan Moore, Lucy Savitz, Jason Scott, Jef Huntington, Scott Evans, Mike Rubin, Connie Price, Walt Biffl

  • General project status review
    • Task 2 - Algorithm testing and site chart reviews
      • Details of the algorithm development were reviewed at SHEA meeting.
      • Chart reviews are done at SLCVAMC and Denver Health-Intermountain chart reviews will be completed following template update based on Denver Health feedback.
        • Issues found with data format
          • Looking at where the data come from and how it was coded
        • The variation in data across all systems will be an important factor to note in the final report
    • Task 3 - data analyses update
      • Code has been verified and will run data (including SLC VAMC) by the end of the week
        • Scott write up report
  • Additional items
    • User manual—pulling documentation across all tasks to inform the manual
    • Data from nursing focus groups will be included in the next monthly report
    • Final report is being updated based on new work as it comes along
    • Extending the work to other surgeries eg, colon, hysterectomy
      • The work could not be an extension of this contract as it is a change in the scope of the work—it will require an add-on of an additional project.
        • Kendall will discuss this question at AHRQ and gauge feasibility of an add-on project
        • Teresa will talk to Sandra about possibility of support from CDC
Page last reviewed December 2012
Internet Citation: Appendix A. Teleconferences with AHRQ & CDC. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/ssi/ssiapa.html