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Research Letter |

Association Between Hospital Characteristics and Performance on the New Hospital-Acquired Condition Reduction Program’s Surgical Site Infection Measures

Christina A. Minami, MD1,2; Allison R. Dahlke, MPH1,2; Cynthia Barnard, MBA3; Christine V. Kinnier, MD, MS4; Ravi R. Rajaram, MD, MS1,2; Gary A. Noskin, MD5; Karl Y. Bilimoria, MD, MS1,2
[+] Author Affiliations
1Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
2Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
3Division of Quality, Northwestern Memorial HealthCare, Chicago, Illinois
4Department of Surgery, Massachusetts General Hospital, Boston
5Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2016;151(8):777-779. doi:10.1001/jamasurg.2016.0408.
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This study evaluates the association between hospital characteristics and surgical site infection measures.

The Centers for Medicare and Medicaid Services Hospital-Acquired Condition (HAC) Reduction Program implemented financial penalties for poorly performing hospitals in federal fiscal year 2015. However, higher-quality hospitals appear to be penalized significantly more often in the HAC program than lower-quality hospitals.1 In federal fiscal year 2016, surgical site infection (SSI) outcome measures for colon surgery and abdominal hysterectomy will be incorporated into the HAC program. Our objective was to evaluate the association between hospital characteristics and SSI measures.

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Figure.
Hospital Surgical Site Infection (SSI) Performance by Hospital Summary Score

Hospital quality summary score includes the following variables: (1) inpatient admission volume, (2) Joint Commission accreditation, (3) Commission on Cancer accreditation, (4) presence of transplant services, (5) level I trauma center status, (6) nurse to bed ratio, (7) Council of Teaching Hospitals membership, and (8) clinical surgical registry participation. SIR indicates standardized infection ratio (risk-adjusted observed to expected ratio for hospital-acquired infections [a score of <1 indicates fewer infections than expected, a score of 1 indicates an expected number of infections, and a score of >1 indicates more infections that expected.]). Error bars indicate 95% CIs.

aDetermined by use of the Cochran-Armitage test for trends.

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