“SCIP adherence was neither associated with a lower surgical site infection rate at the patient level, nor with lower hospital surgical site infection rates,” said lead author Mary Hawn, MD, MPH, associate professor of surgery at the University of Alabama and a staff surgeon at the VA in Birmingham, Ala. An analysis of 112 Veterans Affairs hospitals showed that risk-adjusted surgical site infection (SSI) rates remained stable between 2005 and 2009, even though hospital adherence to SCIP infection control measures improved over the same period.
The study findings raise questions about releasing SCIP adherence information to the public, said researchers.
Currently, this information is given to third-party payers, administrators and patients, who often use it as a gauge for a hospital’s quality. Adherence figures are available online at Hospital Compare (http://www.hospitalcompare.hhs.gov).
SCIP was implemented in 2006 with the goal of reducing surgical complications by 2010. Since then, the Centers for Medicare & Medicaid Services made it mandatory for hospitals to publicly report surgical processes of care, including infection prevention measures, rather than clinical outcomes. The agency requires two sets of SCIP measures for infection and venous thromboembolism be reported publicly. Hospitals must submit data quarterly, which are then posted online.
“The policy of continued SCIP measurement for public reporting and payment should be re-evaluated,” said Dr. Hawn.
Dr. Hawn’s study is the fourth study in the past year to show no association between SSI rates and adherence to SCIP measures (JAMA 2010;303:2479-2485; JACS 2010;211:705-714; Arch Surg 2010 Oct;145:999-1004). Dr. Hawn’s is the only study to use patient-level data to study multiple SCIP measures and SSI assessed by a quality-tracking system.
Donald Fry, MD, executive vice president at the think tank Michael Pine and Associates and an adjunct professor of surgery at Northwestern University, both in Chicago, said the studies show that “it’s almost impossible to identify any improvement” in SSIs as a result of the SCIP measures.
Dr. Fry, who was instrumental in organizing the original surgical infection project, believes that the SCIP measures are scientifically valid but are not enough. Infection control involves far more variables than those monitored by SCIP.