title: Truth in Reporting: How Data Capture Methods Obfuscate Actual Surgical Site Infection Rates within a Health Care Network System.
abstract: BACKGROUND
  Two systems measure surgical site infection rates following colorectal surgeries: the American College of Surgeons National Surgical Quality Improvement Program and the Centers for Disease Control and Prevention National Healthcare Safety Network. The Centers for Medicare & Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons.
  
  
  OBJECTIVE
  This study aimed to compare database concordance.
  
  
  METHODS
  This is a multi-institution cohort study of systemwide Colorectal Surgery Collaborative. The National Surgical Quality Improvement Program requires rigorous, standardized data capture techniques; National Healthcare Safety Network allows 5 data capture techniques. Standardized surgical site infection rates were compared between databases. The Cohen κ-coefficient was calculated.
  
  
  METHODS
  This study was conducted at Boston-area hospitals.
  
  
  METHODS
  National Healthcare Safety Network or National Surgical Quality Improvement Program patients undergoing colorectal surgery were included.
  
  
  METHODS
  Standardized surgical site infection rates were the primary outcomes of interest.
  
  
  RESULTS
  Thirty-day surgical site infection rates of 3547 (National Surgical Quality Improvement Program) vs 5179 (National Healthcare Safety Network) colorectal procedures (2012-2014). Discrepancies appeared: National Surgical Quality Improvement Program database of hospital 1 (N = 1480 patients) routinely found surgical site infection rates of approximately 10%, routinely deemed rate "exemplary" or "as expected" (100%). National Healthcare Safety Network data from the same hospital and time period (N = 1881) revealed a similar overall surgical site infection rate (10%), but standardized rates were deemed "worse than national average" 80% of the time. Overall, hospitals using less rigorous capture methods had improved surgical site infection rates for National Healthcare Safety Network compared with standardized National Surgical Quality Improvement Program reports. The correlation coefficient between standardized infection rates was 0.03 (p = 0.88). During 25 site-time period observations, National Surgical Quality Improvement Program and National Healthcare Safety Network data matched for 52% of observations (13/25). κ = 0.10 (95% CI, -0.1366 to 0.3402; p = 0.403), indicating poor agreement.
  
  
  CONCLUSIONS
  This study investigated hospitals located in the Northeastern United States only.
  
  
  CONCLUSIONS
  Variation in Centers for Medicare & Medicaid Services-mandated National Healthcare Safety Network infection surveillance methodology leads to unreliable results, which is apparent when these results are compared with standardized data. High-quality data would improve care quality and compare outcomes among institutions.
authors.affiliation: 1 Division of General and GI Surgery, Massachusetts General Hospital, Boston, Massachusetts 2 Codman Center, Massachusetts General Hospital, Boston, Massachusetts 3 Department of Quality, Safety, and Value, Partners Healthcare, Boston, Massachusetts 4 Department of Surgery, Newton Wellesley Hospital, Newton, Massachusetts 5 Department of Surgery, North Shore Medical Center, Salem, Massachusetts 6 Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 7 Department of Surgery, Faulkner Hospital, Boston, Massachusetts.
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
authors.forename: Christy E
authors.initials: CE
authors.lastname: Cauley
authors.forename: Donna
authors.initials: D
authors.lastname: Antonelli
authors.forename: Sarah
authors.initials: S
authors.lastname: Bird
authors.forename: David
authors.initials: D
authors.lastname: Rattner
authors.forename: Matthew
authors.initials: M
authors.lastname: Hutter
authors.forename: Sadiqa
authors.initials: S
authors.lastname: Mahmood
authors.forename: Deborah
authors.initials: D
authors.lastname: Schnipper
authors.forename: Marc
authors.initials: M
authors.lastname: Rubin
authors.forename: Ronald
authors.initials: R
authors.lastname: Bleday
authors.forename: Pardon
authors.initials: P
authors.lastname: Kenney
authors.forename: David
authors.initials: D
authors.lastname: Berger
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D014487:Centers for Medicare and Medicaid Services, U.S.; D003082:Colectomy; D003125:Colostomy; D000068598:Data Accuracy; D003625:Data Collection; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D012955:Societies, Medical; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States