Identifying worsening surgical site infection performance: control charts versus risk-adjusted rate outlier status.
Control charts are used in industry to monitor performance and are being used increasingly in hospitals as a quality improvement tool. The authors' objective was to determine if control charts using surgical site infection (SSI) rates predict changes in outlier status for risk-adjusted SSI rates using data from a surgical registry, the American College of Surgeons National Surgical Quality Improvement Program. Control charts of monthly SSI rates for 100 hospitals were analyzed for indicators of a performance change in 2009 (vs 2008) using standard rules. Hospitals also were classified as having better, worse, or no change in outlier status for risk-adjusted SSI rates in 2009 (vs 2008). There was moderate agreement between these methods (weighted κ = 0.401). Control charts predicted nonworsening performance well (specificity = 92.9%) and identified changes in SSI performance sooner; however, they failed to identify 31.2% of hospitals with worsened outlier status. This study demonstrates that these quality measurement tools have unique strengths and weaknesses and are complementary uses of the same clinical data source.
University of California, Los Angeles, CA 90095, USA. elawson@mednet.ucla.edu
Elise H
EH
Lawson
Bruce Lee
BL
Hall
Nestor F
NF
Esnaola
Clifford Y
CY
Ko
D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D020379:Risk Adjustment; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States