Garcia Nicole, Fogel Sandy, Baker Christopher, Remine Stephen, Jones Jim
Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia, USA.
Am Surg. 2012 Jun;78(6):653-6.
The Surgical Care Improvement Project (SCIP) is a project that focuses on improving surgical care by reducing surgical morbidity and mortality by 25 per cent by 2010. Starting in 2011, SCIP compliance affects Medicare and Medicaid reimbursement rates. Although SCIP reinforces better practices in surgical care, does compliance with SCIP measures actually result in a decrease in surgical morbidity and mortality? This study examined compliance with the SCIP surgical site infection (SSI) module (prophylactic antibiotic received within 1 hour before surgical incision) during 2009 to 2010 (n = 703) to determine whether patients compliant with SCIP data had a correlation with SSI rates as reported by National Surgery Quality Improvement Program (NSQIP) data for the same time period. We found no statistically significant association in patients that have failed SCIP INF1 in the years 2009 to 2010 (n = 43) and the rates of SSI (n = 0) for the same time period. These data suggest that SCIP compliance should not be used to determine Medicare and Medicaid reimbursement rates because there is no correlation between failure of SCIP INF1 and SSI. Instead, further effort should be placed on developing tools designed to acknowledge outcome measures that result in decreased morbidity/mortality and change practices accordingly such as NSQIP.
外科护理改进项目（SCIP）是一个致力于通过到2010年将手术发病率和死亡率降低25%来改善外科护理的项目。从2011年开始，SCIP合规情况会影响医疗保险和医疗补助的报销率。尽管SCIP强化了外科护理中的更佳做法，但遵守SCIP措施是否真能降低手术发病率和死亡率呢？本研究调查了2009年至2010年期间（n = 703）对SCIP手术部位感染（SSI）模块（手术切口前1小时内接受预防性抗生素治疗）的遵守情况，以确定符合SCIP数据的患者与同一时期国家外科质量改进计划（NSQIP）数据报告的SSI发生率之间是否存在关联。我们发现，在2009年至2010年期间未通过SCIP INF1的患者（n = 43）与同一时期的SSI发生率（n = 0）之间不存在统计学上的显著关联。这些数据表明，不应将SCIP合规情况用于确定医疗保险和医疗补助的报销率，因为SCIP INF1未达标与SSI之间没有关联。相反，应进一步努力开发旨在认可能降低发病率/死亡率的结果指标并据此改变做法的工具，如NSQIP。
