title: Use of Medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery.
abstract: OBJECTIVE
  To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates.
  
  
  METHODS
  We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix-adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery. We then reviewed medical records of randomly selected patients to assess whether chart-confirmed SSI risk was higher in hospitals in the worst deciles compared with the best deciles.
  
  
  METHODS
  Fee-for-service Medicare beneficiaries who underwent CABG in these hospitals in 2005.
  
  
  RESULTS
  We evaluated 114,673 patients who underwent CABG in 671 hospitals. In the best decile, 7.8% (958/12,307) of patients had an SSI-related code, compared with 24.8% (2,747/11,068) in the worst decile ([Formula: see text]). Medical record review confirmed SSI in 40% (388/980) of those with SSI-related codes. In the best decile, the chart-confirmed annual SSI rate was 3.2%, compared with 9.4% in the worst decile, with an adjusted odds ratio of SSI of 2.7 (confidence interval, 2.2-3.3; [Formula: see text]) for CABG performed in a worst-decile hospital compared with a best-decile hospital.
  
  
  CONCLUSIONS
  Claims data can identify groups of hospitals with unusually high or low post-CABG SSI rates. Assessment of claims is more reproducible and efficient than current surveillance methods. This example of secondary use of routinely recorded electronic health information to assess quality of care can identify hospitals that may benefit from prevention programs.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA. sshuang@uci.edu
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
authors.forename: Hilary
authors.initials: H
authors.lastname: Placzek
authors.forename: James
authors.initials: J
authors.lastname: Livingston
authors.forename: Allen
authors.initials: A
authors.lastname: Ma
authors.forename: Fallon
authors.initials: F
authors.lastname: Onufrak
authors.forename: Julie
authors.initials: J
authors.lastname: Lankiewicz
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: Dale
authors.initials: D
authors.lastname: Bratzler
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.forename: Rosie
authors.initials: R
authors.lastname: Lyles
authors.forename: Yosef
authors.initials: Y
authors.lastname: Khan
authors.forename: Paula
authors.initials: P
authors.lastname: Wright
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Yokoe
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: Kurt
authors.initials: K
authors.lastname: Stevenson
authors.forename: David
authors.initials: D
authors.lastname: Hooper
authors.forename: Johanna
authors.initials: J
authors.lastname: Vostok
authors.forename: Rupak
authors.initials: R
authors.lastname: Datta
authors.forename: Wato
authors.initials: W
authors.lastname: Nsa
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016022:Case-Control Studies; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology