title: Use of Medicare claims to identify US hospitals with a high rate of surgical site infection after hip arthroplasty.
abstract: OBJECTIVE
  To assess the ability of Medicare claims to identify US hospitals with high rates of surgical site infection (SSI) after hip arthroplasty.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Acute care US hospitals.
  
  
  METHODS
  Fee-for-service Medicare patients 65 years of age and older who underwent hip arthroplasty in US hospitals from 2005 through 2007.
  
  
  METHODS
  Hospital rankings were derived from claims codes suggestive of SSI, adjusted for age, sex, and comorbidities, while using generalized linear mixed models to account for hospital volume. Medical records were obtained for validation of infection on a random sample of patients from hospitals ranked in the best and worst deciles of performance. We then calculated the risk-adjusted odds of developing a chart-confirmed SSI after hip arthroplasty in hospitals ranked by claims into worst- versus best-performing deciles.
  
  
  RESULTS
  Among 524,892 eligible Medicare patients who underwent hip arthroplasty at 3,296 US hospitals, a patient who underwent surgery in a hospital ranked in the worst-performing decile based on claims-based evidence of SSI had 2.9-fold higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.2-3.7).
  
  
  CONCLUSIONS
  Medicare claims successfully distinguished between hospitals with high and low SSI rates following hip arthroplasty. These claims can identify potential outlier hospitals that merit further evaluation. This strategy can also be used to validate the completeness of public reporting of SSI.
authors.affiliation: Departmentof Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02115, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Calderwood
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Allen
authors.initials: A
authors.lastname: Ma
authors.forename: Christina B
authors.initials: CB
authors.lastname: Bruce
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Kaganov
authors.forename: Claire
authors.initials: C
authors.lastname: Canning
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019985:Benchmarking / Q000706:statistics & numerical data*; D003625:Data Collection / Q000379:methods*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020379:Risk Adjustment; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology