National Claims-Based Quality Measures for Surgical Site Infections

The Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS) all expressed interest in developing validated quality measures for inter-hospital comparisons of healthcare associated infections, including surgical site infections (SSIs). Since Hospitals reporting higher SSI risks will receive lower reimbursement, there is a need for improved surveillance and validated quality measures targeting high-risk surgeries, both in major surgical centers and in hospitals with lower procedure volumes. Claims data have been shown to provide more standardized and comprehensive capture compared to traditional SSI surveillance by hospital infection control programs. 

Through this project, we have expanded our prior work on the use of claims data for SSI surveillance by targeting procedures mandated by states for public reporting and proposed for value-based purchasing by CMS. More specifically, we have: 
1) Extended our previously successful claims-based surveillance following coronary artery bypass graft (CABG) surgery and hip arthroplasty to identify hospitals with an unusually high risk of SSI following knee arthroplasty, another high volume and high cost procedure, 
2) Identified and validated claims-based methods for estimating the risk of deep incisional and organ/space infections following CABG surgery, hip arthroplasty, and knee arthroplasty, and used these methods to determine year-to-year predictive utility of hospital rankings - Our paper showing that past performance has limited utility in predicting future performance was published by Medical Care, and another paper evaluating longitudinal SSI trends for CABG and hip arthroplasty with a comparison to publicly reported SSI data was also published in Open Forum. 
3) Assessed the generalizability of hospital SSI rankings using Medicare claims compared to hospital rankings derived from all-payer claims databases, and from rankings based on state mandated reporting to NHSN, and 
4) Evaluated statistical approaches to evaluate the performance of hospitals with low procedure volumes.

Calderwood MS, Kleinman K, Huang SS, Murphy MV, Yokoe DS, Platt R. Surgical Site Infections: Volume-Outcome Relationship and Year-to-Year Stability of Performance Ranking. Med Care. 2017 Jan;55(1):79-85


Calderwood MS, Kleinman K, Murphy MV, Platt R, Huang SS. Improving public reporting and data validation for complex surgical site infections following coronary artery bypass graft surgery and hip arthroplasty. Open Forum Infect Dis. 2014;1(3):ofu106.


Calderwood MS, Kleinman K, Bratzler DW, Ma A, Kaganov RE, Bruce CB, Balaconis EC, Canning C, Platt R, Huang SS. Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery. Med Care. 2014;52(10):918-25.


Letourneau AR, Calderwood MS, Huang SS, Bratzler DW, Ma A, Yokoe DS. Harnessing claims to improve detection of surgical site infections following hysterectomy and colorectal surgery. Infect Control Hosp Epidemiol. 2013;34(12):1321-3.


Calderwood MS, Kleinman K, Bratzler DW, Ma A, Bruce CB, Kaganov RE, Canning C, Platt R, Huang SS. Use of Medicare claims to identify US hospitals with a high rate of surgical site infection after hip arthroplasty. Infect Control Hosp Epidemiol. 2013;34(1):31-9.


Yokoe DS, Avery TR, Platt R, Huang SS. Reporting surgical site infections following total hip and knee arthroplasty: impact of limiting surveillance to the operative hospital. Clin Infect Dis. 2013;57(9):1282-8.


Lankiewicz JD, Yokoe DS, Olsen MA, Onufrak F, Fraser VJ, Stevenson K, Khan Y, Hooper D, Platt R, Huang SS. Beyond 30 days: does limiting the duration of surgical site infection follow-up limit detection? Infect Control Hosp Epidemiol. 2012;33(2):202-4.


Use of Medicare diagnosis and procedure codes to improve detection of surgical site infections following hip arthroplasty, knee arthroplasty, and vascular surgery. Infect Control Hosp Epidemiol. 2012;33(1):40-9.

Principal Investigator: Richard Platt, MD, MSc

Funder: Agency for Healthcare Quality and Research