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Quality check of a quality measure: surgical wound classification discrepancies impact risk-stratified surgical site infection rates in pediatric appendicitis.

Abstract：

BACKGROUND:The impact of quality measures in health care and reimbursement is growing. Ensuring the accuracy of quality measures, including any risk-stratification variables, is necessary. Surgical site infection rates, risk stratified by surgical wound classification (SWC) among other variables, are increasingly considered as quality measures. We hypothesized that hospital-documented and diagnosis-based SWCs are frequently discordant and that diagnosis-based SWCs better predict surgical site infection rates. STUDY DESIGN:All pediatric patients (ie, younger than 18 years old) at a single institution who underwent an appendectomy for appendicitis between October 1, 2010 and August 31, 2011 were included. Each chart was reviewed to determine the hospital-documented SWC, which is recorded by the circulating nurse (options included clean, clean-contaminated, contaminated, and dirty); SWC based on the surgeons' postoperative diagnosis, including contaminated (ie, acute nonperforated, nongangrenous appendicitis), dirty (ie, gangrenous and perforated appendicitis), and 30-day postoperative surgical site infections. RESULTS:Of the 312 evaluated appendicitis cases, the diagnosis-based and circulating nurse-based SWCs differed in 288 (92%) cases. The circulating nurse-based and diagnosis-based SWCs differed by more than one SWC in 176 (56%) cases. Surgical site infections were associated with worsening diagnosis-based SWC, but not with circulating nurse-based SWC. CONCLUSIONS:Significant discordance exists between hospital documentation by the circulating nurse- and surgeon diagnosis-based SWCs. Inconsistency in risk-stratified quality measures can have a significant effect on outcomes measures, which can lead to misdirection of quality-improvement efforts, incorrect inter-hospital rating, reduced reimbursements, and public misperceptions about quality of care.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Levy SM,Holzmann-Pazgal G,Lally KP,Davis K,Kao LS,Tsao K

doi

10.1016/j.jamcollsurg.2013.07.398

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

969-73

issue

6

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(13)00924-1

journal_volume

217

pub_type

杂志文章

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