title: Adherence to surgical care improvement project measures and the association with postoperative infections.
abstract: BACKGROUND
  The Surgical Care Improvement Project (SCIP) aims to reduce surgical infectious complication rates through measurement and reporting of 6 infection-prevention process-of-care measures. However, an association between SCIP performance and clinical outcomes has not been demonstrated.
  
  
  OBJECTIVE
  To examine the relationship between SCIP infection-prevention process-of-care measures and postoperative infection rates.
  
  
  METHODS
  A retrospective cohort study, using Premier Inc's Perspective Database for discharges between July 1, 2006 and March 31, 2008, of 405 720 patients (69% white and 11% black; 46% Medicare patients; and 68% elective surgical cases) from 398 hospitals in the United States for whom SCIP performance was recorded and submitted for public report on the Hospital Compare Web site. Three original infection-prevention measures (S-INF-Core) and all 6 infection-prevention measures (S-INF) were aggregated into 2 separate all-or-none composite scores. Hierarchical logistical models were used to assess process-of-care relationships at the patient level while accounting for hospital characteristics.
  
  
  METHODS
  The ability of reported adherence to SCIP infection-prevention process-of-care measures (using the 2 composite scores of S-INF and S-INF-Core) to predict postoperative infections.
  
  
  RESULTS
  There were 3996 documented postoperative infections. The S-INF composite process-of-care measure predicted a decrease in postoperative infection rates from 14.2 to 6.8 per 1000 discharges (adjusted odds ratio, 0.85; 95% confidence interval, 0.76-0.95). The S-INF-Core composite process-of-care measure predicted a decrease in postoperative infection rates from 11.5 to 5.3 per 1000 discharges (adjusted odds ratio, 0.86; 95% confidence interval, 0.74-1.01), which was not a statistically significantly lower probability of infection. None of the individual SCIP measures were significantly associated with a lower probability of infection.
  
  
  CONCLUSIONS
  Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infection-prevention score was associated with a lower probability of developing a postoperative infection. However, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was not associated with a significantly lower probability of infection.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. Jonah.Stulberg@case.edu
authors.forename: Jonah J
authors.initials: JJ
authors.lastname: Stulberg
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.forename: Duncan V
authors.initials: DV
authors.lastname: Neuhauser
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
authors.forename: Pingfu
authors.initials: P
authors.lastname: Fu
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014481:United States; D055815:Young Adult