Current system doesn't accurately portray extent of the problem, study says
TUESDAY, June 22 (HealthDay News) -- Current measures of how well hospitals control post-operative infections don't reflect actual results, a new study contends.
The authors of the study in the June 23/30 issue of the Journal of the American Medical Association propose a new way of reporting on infection control which, they say, would ultimately better reflect what's happening in hospitals.
This, in turn, would give patients more useful information with which to choose the right hospital for them. The data is already available on a publicly available Web site, the study authors said.
"We found that what is currently reported is not predictive of outcome," said study lead author Dr. Jonah J. Stulberg, a recent graduate of Case Western Reserve University School of Medicine who is about to begin his residency in the department of surgery. "Data on the Web site doesn't tell you whether you have a decreased level of infection . . . We've come up with a much stronger measure of quality care."
Dr. Clifford Y. Ko is director of the division of research and optimal patient care at the American College of Surgeons and a professor of surgery and health services at the UCLA Schools of Medicine and Public Health. He said: "The bottom line is that the metrics we're using to measure quality are not exactly as good as we thought they were. There was little or no correlation between doing the right thing and having a better outcome."
The American College of Surgeons did a similar study with similar findings a few years back and is now working with the U.S. Centers for Disease Control and Prevention to come up with ways to better measure infection control at hospitals.
The Surgical Care Improvement Project (SCIP) was established in 2006 to cut the rate of complications after surgery. It is based on 20 measures of patient care -- six of them related to prevention of post-operative infection.
Hospital-by-hospital data has been made available on a Web site to help guide patient decisions about which facility to choose when they need surgical care. Whether hospitals participate in the program influences their reimbursements from Medicare.
The authors of the new study wanted to know if the "reported rates of adherence of actually doing these things [the six infection-control quality measures] were actually associated with a decreased risk of infection," Stulberg said.
The six measures include whether antibiotics were given an hour before surgery; whether the appropriate antibiotics were given; and whether the patients were shaved with a clipper rather than a razor. Data has overwhelmingly supported clippers for several decades, because they result in fewer microabrasions to the skin that could invite infection, Stulberg explained.
The study authors looked at discharge records of nearly 406,000 patients at 398 U.S. hospitals all participating in the SCIP program. The discharges took place between July 1, 2006 and March 31, 2008.
The current recommended procedure for reporting data did not reflect infection rates as well as the new system developed by the study authors, the authors said.
The current measure looks at how a hospital is doing overall in one of the six categories (antibiotic administration, for instance), while the proposed system looks at how many patients received all six procedures correctly (the "all-or-none" composite score).
Although infections are down the past few years, "getting better is not good enough," Stulberg said. "This is a way for us to push this program one step further without changing the administration and reporting [procedures] and all the heavy lifting."
The Hospital Compare Web site has information on how hospitals rate.
SOURCES: Jonah J. Stulberg, M.D., Ph.D., graduate, Case Western Reserve University School of Medicine, Cleveland; Clifford Y. Ko, M.D., director of the Division of Research and Optimal Patient Care, American College of Surgeons, and professor of surgery and health services, UCLA Schools of Medicine and Public Health, Los Angeles; June 23/30, 2010, Journal of the American Medical Association
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