Association of surgical care improvement project infection-related process measure compliance with risk-adjusted outcomes: implications for quality measurement.
BACKGROUND
Facility-level process measure adherence is being publicly reported. However, the association between measure adherence and surgical outcomes is not well-established. Our objective was to determine the degree to which Surgical Care Improvement Project (SCIP) process measures are associated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk-adjusted outcomes.


METHODS
This cross-sectional study included hospitals participating in the ACS NSQIP and SCIP (n = 200). ACS NSQIP outcomes (30-day overall morbidity, serious morbidity, surgical site infections [SSI], and mortality) and adherence to SCIP SSI-related process measures (from the Hospital Compare database) were collected from January 1, 2008, through December 31, 2008. Hospital-level correlation coefficients between compliance with 4 process measures (ie, antibiotic administration within 1 hour before incision [SCIP-1]; appropriate antibiotic prophylaxis [SCIP-2]; antibiotic discontinuation within 24 hours after surgery [SCIP-3]; and appropriate hair removal [SCIP 6]) and 4 risk-adjusted outcomes were calculated. Regression analyses estimated the contribution of process measure adherence to risk-adjusted outcomes.


RESULTS
Of 211 ACS NSQIP hospitals, 95% had data reported by Hospital Compare. Depending on the measure, hospital-level compliance ranged from 60% to 100%. Of the 16 correlations, 15 demonstrated nonsignificant associations with risk-adjusted outcomes. The exception was the relationship between SCIP-2 and SSI (p = 0.004). SCIP-1 demonstrated an intriguing but nonsignificant relationship with SSI (p = 0.08) and overall morbidity (p = 0.08). Although adherence to SCIP-2 was a significant predictor of risk-adjusted SSI (p < 0.0001) and overall morbidity (p < 0.0001), inclusion of compliance for SCIP-1 and SCIP-2 caused only slight improvement in model quality.


CONCLUSIONS
Better adherence to infection-related process measures over the observed range was not significantly associated with better outcomes with one exception. Different measures of quality might be needed for surgical infection.
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA. angieingraham@gmail.com
Angela M
AM
Ingraham
Mark E
ME
Cohen
Karl Y
KY
Bilimoria
Justin B
JB
Dimick
Karen E
KE
Richards
Mehul V
MV
Raval
Lee A
LA
Fleisher
Bruce L
BL
Hall
Clifford Y
CY
Ko
D019072:Antibiotic Prophylaxis; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D017052:Hospital Mortality; D006801:Humans; D017053:Infection Control / Q000592:standards*; D009017:Morbidity; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012044:Regression Analysis; D012107:Research Design; D020379:Risk Adjustment; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000592:standards*; D013530:Surgical Wound Infection / Q000517:prevention & control; D014481:United States