Identifying Worsening Surgical Site Infection Performance: Control Charts Versus Risk-Adjusted Rate Outlier Status

Elise H. Lawson, Bruce Lee Hall, Nestor F. Esnaola, Clifford Y. Ko

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Control charts are used in industry to monitor performance and are being used increasingly in hospitals as a quality improvement tool. The authors' objective was to determine if control charts using surgical site infection (SSI) rates predict changes in outlier status for risk-adjusted SSI rates using data from a surgical registry, the American College of Surgeons National Surgical Quality Improvement Program. Control charts of monthly SSI rates for 100 hospitals were analyzed for indicators of a performance change in 2009 (vs 2008) using standard rules. Hospitals also were classified as having better, worse, or no change in outlier status for risk-adjusted SSI rates in 2009 (vs 2008). There was moderate agreement between these methods (weighted κ = 0.401). Control charts predicted nonworsening performance well (specificity = 92.9%) and identified changes in SSI performance sooner; however, they failed to identify 31.2% of hospitals with worsened outlier status. This study demonstrates that these quality measurement tools have unique strengths and weaknesses and are complementary uses of the same clinical data source.

Original languageEnglish (US)
Pages (from-to)391-397
Number of pages7
JournalAmerican Journal of Medical Quality
Volume27
Issue number5
DOIs
StatePublished - Sep 2012

Keywords

  • control charts
  • risk adjustment
  • surgery
  • surgical site infection

ASJC Scopus subject areas

  • Health Policy

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