Risk-adjustment models for clean and colorectal surgery surgical site infection for the Spanish health system
| Autor: | Ismael Martínez Nicolás, Victoriano Soria Aledo, José Andrés García Marín, Daniel García |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Quality management 030230 surgery Logistic regression 03 medical and health sciences 0302 clinical medicine Risk Factors Health care Humans Surgical Wound Infection Medicine Retrospective Studies Receiver operating characteristic business.industry Health Policy Public Health Environmental and Occupational Health Regression analysis General Medicine Benchmarking Confidence interval Colorectal surgery Logistic Models 030220 oncology & carcinogenesis Emergency medicine Risk Adjustment business Colorectal Surgery |
| Zdroj: | International Journal for Quality in Health Care. 32:599-608 |
| ISSN: | 1464-3677 1353-4505 |
| Popis: | Objective To develop risk-adjusted models for two quality indicators addressing surgical site infection (SSI) in clean and colorectal surgery, to be used for benchmarking and quality improvement in the Spanish National Health System. Study design A literature review was undertaken to identify candidate adjustment variables. The candidate variables were revised by clinical experts to confirm their clinical relevance to SSI; experts also offered additional candidate variables that were not identified in the literature review. Two risk-adjustment models were developed using multiple logistic regression thus allowing calculation of the adjusted indicator rates. Data source The two SSI indicators, with their corresponding risk-adjustment models, were calculated from administrative databases obtained from nine public hospitals. A dataset was obtained from a 10-year period (2006–2015), and it included data from 21 571 clean surgery patients and 6325 colorectal surgery patients. Analysis methods Risk-adjustment regression models were constructed using Spanish National Health System data. Models were analysed so as to prevent overfitting, then tested for calibration and discrimination and finally bootstrapped. Results Ten adjustment variables were identified for clean surgery SSI, and 23 for colorectal surgery SSI. The final adjustment models showed fair calibration (Hosmer–Lemeshow: clean surgery χ2 = 6.56, P = 0.58; colorectal surgery χ2 = 6.69, P = 0.57) and discrimination (area under receiver operating characteristic [ROC] curve: clean surgery 0.72, 95% confidence interval [CI] 0.67–0.77; colorectal surgery 0.62, 95% CI 0.60–0.65). Conclusions The proposed risk-adjustment models can be used to explain patient-based differences among healthcare providers. They can be used to adjust the two proposed SSI indicators. |
| Databáze: | OpenAIRE |
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