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首页> 外文期刊>Infection control and hospital epidemiology >Detection of postoperative surgical-site infections: comparison of health plan-based surveillance with hospital-based programs.
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Detection of postoperative surgical-site infections: comparison of health plan-based surveillance with hospital-based programs.

机译：术后手术部位感染的检测：基于健康计划的监视与基于医院的程序的比较。

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BACKGROUND: Review of health plan administrative data has been shown to be more sensitive than other methods for identifying postdischarge surgical-site infections (SSIs), but there has not been a direct comparison between this method and hospital-based surveillance for all infections, including those diagnosed before discharge. We compared these two methods for identifying SSIs following coronary artery bypass graft (CABG) procedures. METHODS: We studied 1,352 CABG procedures performed among members of one health plan from March 1993 through June 1997. Health plan administrative records were reviewed based on claims containing diagnoses or procedures suggestive of infection or outpatient dispensing of antibiotics appropriate for SSI. Hospital-based surveillance information was also reviewed. SSI rates were calculated based on the total events identified by either mechanism. RESULTS: Postdischarge information was reviewed for 328 (85%) of 388 procedures. SSIs were confirmed in 167 patients (13% overallrisk of confirmed SSI; range, 3% to 14% in the 5 hospitals). The overall sensitivity of hospital-based surveillance was 49.7% (83 of 167), and that of health plan data was 71.8% (120 of 167). There was no significant difference among hospitals in the sensitivity of either surveillance mechanism. CONCLUSIONS: Surveillance based on health plan data identified more postoperative infections, including those occurring before discharge, than did hospital-based surveillance. Screening administrative data and pharmacy activity may be an important adjunct to SSI surveillance, allowing efficient comparison of hospital-specific rates. Interpretation of differences among hospitals' infection rates requires case mix adjustment and understanding of variations in hospitals' discharge diagnosis coding practices.
机译：背景：对健康计划行政数据的审查已显示出比其他方法更能识别出院后手术部位感染（SSI），但该方法与基于医院的所有感染监测方法之间没有直接比较，包括出院前确诊者。我们比较了两种在冠状动脉旁路移植术（CABG）手术后确定SSI的方法。方法：我们研究了1993年3月至1997年6月在一项健康计划的成员中执行的1,352例CABG程序。根据包含诊断或建议感染或建议门诊分配适用于SSI的抗生素的程序的声明，对健康计划的行政记录进行了审查。还审查了基于医院的监视信息。 SSI率是根据任一机制确定的总事件计算得出的。结果：对388例手术中的328例（85％）的出院后信息进行了审查。在167例患者中确诊了SSI（确诊SSI的总风险为13％;范围在5所医院中为3％至14％）。医院监测的总体敏感性为49.7％（167的83），而健康计划数据的总体敏感性为71.8％（167的120）。两种监测机制的敏感性在医院之间没有显着差异。结论：根据健康计划数据进行的监测发现，与医院监测相比，术后感染（包括出院前发生的感染）更多。筛选行政数据和药房活动可能是SSI监测的重要辅助手段，从而可以有效地比较医院特定的比率。解释医院感染率之间的差异需要调整病例组合，并了解医院出院诊断编码做法的差异。

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