Infection Control & Hospital Epidemiology (2019), 40, 208–210 doi:10.1017/ice.2018.310
Concise Communication
Comparison of hospital surgical site infection rates and rankings using claims versus National Healthcare Safety Network surveillance data
Chanu Rhee MD, MPH1,2, Rui Wang PhD1, Maximilian S. Jentzsch MS1,3, Carly Broadwell BS1,3, Heather Hsu MD,
MPH1,4, Robert Jin MS1, Kelly Horan MPH1 and Grace M. Lee MD, MPH1,5 1Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, 2Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, 3Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 4Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts and 5Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
Abstract
National policies target healthcare-associated infections using medical claims and National Healthcare Safety Network surveillance data. We found low concordance between the 2 data sources in rates and rankings for surgical site infection following colon surgery in 155 hospitals, underscoring the limitations in evaluating hospital quality by claims data.
(Received 4 September 2018; accepted 31 October 2018; electronically published 4 December 2018)
National reimbursement policies seek to align quality and cost and reduce preventable harm, including healthcare-associated infections (HAIs). The success of these policies depends on reli- able metrics. Administrative claims data are commonly used to track HAIs and other healthcare-associated conditions given their convenience, but they are limited by variable coding practices and the potential influence of changing reimbursement policies.1 As a result, federal value-based incentive programs (VBIPs) incorpo- rate HAI rates reported to the National Healthcare Safety Net- work (NHSN) in determinations of hospital performance. However, the Centers for Medicare and Medicaid Services
(CMS) Hospital-Acquired Conditions Present-on-Admission programs still rely on claims-based billing codes. Furthermore, public reporting and VBIPs continue to depend on claims-based metrics for non-HAI outcomes. In 2019, VBIPs and the Hospital Inpatient Quality Reporting program will incorporate 5 and 31 claims-based metrics, respectively.2 Examining HAI data can provide an important window into
the strengths and limitations of using administrative data to determine hospital performance given the presence of an alter- nate, prospectively collected data source. Although prior work has suggested poor concordance between HAIs identified by admin- istrative data and NHSN case definitions,1,3,4 little is known about the potential impact of these different surveillance methods on calculated hospital rankings.
Author for correspondence: Chanu Rhee, MD, MPH, Department of Population
Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215. E-mail:
crhee@bwh.harvard.edu
Cite this article: Rhee C, et al. (2019). Comparison of hospital surgical site infection
rates and rankings using claims versus National Healthcare Safety Network surveillance data. Infection Control & Hospital Epidemiology 2019, 40, 208–210. doi: 10.1017/ ice.2018.310
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. In this study, we examined differences in hospital rankings
computed using claims versus NHSN data. We focused on sur- gical site infection following colon surgery (SSI-colon) as a case example to maximize power given that surgical volume and SSI incidence are higher for SSI-colon than for other procedures. We used data from 2012–2014 to ensure a time window free from the influence of reimbursement policies or NHSN case definition changes. We hypothesized that concordance would be poor between the 2 data sources, which could underscore the chal- lenges in measuring hospital quality using administrative data.
Methods
This retrospective cohort study included adult patients admitted to 155 non-federal acute-care hospitals in 7 states that shared NHSN data through the Preventing Avoidable Infectious Com- plications by Adjusting Payment (PAICAP) study. We included admissions in calendar years 2012–2014 from PAICAP hospitals that could be linked to administrative data from the State Inpa- tient Databases, Healthcare Cost and Utilization Project. Hospital characteristics were obtained from the 2011 American Hospital Association Annual Survey. We identified colon surgery procedures and SSIs using NHSN
data, or using claims data with the following previously validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes: 54.0, 54.11, 54.19, 86.04, 86.22, 86.28, 567.21, 567.22, 567.29, 567.38, 569.5, 569.61, 569.81, 682.2, 879.9, 998.31, 998.32, 998.51, 998.59, and 998.6.5 The NHSN limits SSI reporting to 30 days post procedure. For claims, we included SSI codes not present-on-admission (POA) from the index surgical hospitalization, or from any subsequent
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