Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
JAMA. 2010 Jun 23;303(24):2479-85. doi: 10.1001/jama.2010.841.
The Surgical Care Improvement Project (SCIP) aims to reduce surgical infectious complication rates through measurement and reporting of 6 infection-prevention process-of-care measures. However, an association between SCIP performance and clinical outcomes has not been demonstrated.
To examine the relationship between SCIP infection-prevention process-of-care measures and postoperative infection rates.
DESIGN, SETTING, PARTICIPANTS: A retrospective cohort study, using Premier Inc's Perspective Database for discharges between July 1, 2006 and March 31, 2008, of 405 720 patients (69% white and 11% black; 46% Medicare patients; and 68% elective surgical cases) from 398 hospitals in the United States for whom SCIP performance was recorded and submitted for public report on the Hospital Compare Web site. Three original infection-prevention measures (S-INF-Core) and all 6 infection-prevention measures (S-INF) were aggregated into 2 separate all-or-none composite scores. Hierarchical logistical models were used to assess process-of-care relationships at the patient level while accounting for hospital characteristics.
The ability of reported adherence to SCIP infection-prevention process-of-care measures (using the 2 composite scores of S-INF and S-INF-Core) to predict postoperative infections.
There were 3996 documented postoperative infections. The S-INF composite process-of-care measure predicted a decrease in postoperative infection rates from 14.2 to 6.8 per 1000 discharges (adjusted odds ratio, 0.85; 95% confidence interval, 0.76-0.95). The S-INF-Core composite process-of-care measure predicted a decrease in postoperative infection rates from 11.5 to 5.3 per 1000 discharges (adjusted odds ratio, 0.86; 95% confidence interval, 0.74-1.01), which was not a statistically significantly lower probability of infection. None of the individual SCIP measures were significantly associated with a lower probability of infection.
Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infection-prevention score was associated with a lower probability of developing a postoperative infection. However, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was not associated with a significantly lower probability of infection.
外科手术改进项目（SCIP）旨在通过衡量和报告 6 项感染预防护理措施来降低外科手术感染率。然而，SCIP 的表现与临床结果之间的关联尚未得到证实。
检验 SCIP 感染预防护理措施与术后感染率之间的关系。
设计、地点、参与者：一项回顾性队列研究，使用 Premier Inc 的 Perspective 数据库，该数据库包含了 2006 年 7 月 1 日至 2008 年 3 月 31 日期间美国 398 家医院的 405720 名患者出院数据（69%为白人，11%为黑人；46%为医疗保险患者；68%为择期手术病例），这些患者的 SCIP 表现被记录并在 Hospital Compare 网站上进行公开报告。最初的 3 项感染预防措施（S-INF-Core）和所有 6 项感染预防措施（S-INF）被汇总成 2 个单独的全部或无复合评分。使用分层逻辑模型，在考虑医院特征的情况下，在患者水平上评估护理过程与感染之间的关系。
报告的遵守 SCIP 感染预防护理措施（使用 S-INF 和 S-INF-Core 两个复合评分）的能力，以预测术后感染。
共有 3996 例术后感染记录。S-INF 复合护理过程测量预测术后感染率从每千名出院患者 14.2 例下降至 6.8 例（调整后的优势比，0.85；95%置信区间，0.76-0.95）。S-INF-Core 复合护理过程测量预测术后感染率从每千名出院患者 11.5 例下降至 5.3 例（调整后的优势比，0.86；95%置信区间，0.74-1.01），但感染概率降低无统计学意义。SCIP 的个别措施与感染概率降低均无显著相关性。
在报告 SCIP 表现的 Premier Inc Perspective 数据库中的医院中，通过全球全部或无复合感染预防评分测量的依从性与术后感染发生率降低相关。然而，仅以个别 SCIP 措施报告的依从性与感染概率降低无显著相关性，而这是唯一公开报告的表现形式。
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