Adherence rates on six core Surgical Care Improvement Project (SCIP) measures improved annually between 2008 and 2012 by hospitals performing heart valve surgery. The research was performed at the University of Chicago.
“SCIP is a national initiative to help improve surgical care by reducing surgical complications,” said Lisa Sun, MD, an investigator who is now a resident at the University of California, San Francisco. “There is a set of SCIP measures that hospitals try to comply with. How hospitals perform on these metrics is related to Medicare and Medicaid reimbursement and is also publicly recorded.”
Using data from Medicare’s Hospital Compare website (data.medicare.gov/data/hospital-compare), the researchers examined performance on the following six core measures, whose domains involved infection (INF) and venous thromboembolism (VTE):
INF-1: received prophylactic antibiotics within one hour of surgical incision;
INF-2: received appropriate prophylactic antibiotics;
INF-3: prophylactic antibiotics were discontinued within 24 hours of surgery end time;
INF-4: cardiac surgery patients with controlled 6 a.m. blood glucose levels;
VTE-1: treatment ordered to prevent VTE; and
VTE-2: treatment recorded to prevent VTE within 24 hours before or after surgery.
These six measures were selected because they were reported every year during the study period.
As Dr. Sun explained at the 2014 annual meeting of the International Anesthesia Research Society (abstract S-221), only hospitals performing heart valve surgery were included. The average performances for individual measures and the aggregate of all six measures were calculated for each year.
It was found that over the past five years, the average nationwide performances for each of the individual SCIP measures and the aggregate of all six measures improved annually between 2008 and 2012. Indeed, the aggregate adherence rate increased from 91.02% in 2008 to 97.97% in 2012.
Interestingly, it was also found that the number of hospitals performing valve surgeries that also recorded SCIP performance fell from 768 in 2008 to 568 in 2012. “A theory we have is there might be a kind of survivor bias here in which the low performers are dropping off each year or are being culled from the herd,” Dr. Sun reported.
“This information is helpful because SCIP measure performance is used for both public reporting of hospital performance as well as for Medicare and Medicaid reimbursement,” she added. “So for an individual hospital, it’s not enough to have a high adherence rate to SCIP measures, it’s important to continually improve compliance rates because other hospitals around the country are also improving their performance.”
Session moderator George M. Hall, MB, BS, PhD, professor of anesthesia at St. George’s University of London, United Kingdom, wondered how increased adherence might affect patient outcomes. “How do these findings correlate to decreased morbidity and decreased length of stay?” he asked.
“Because if it doesn’t, is it just sort of a self-fulfilling exercise for bureaucrats?”