Improving the Measurement of Surgical Site Infection (SSI) Risk Stratification and Outcome Detection
Monthly Teleconference
Tuesday, 17 November 2009; 12:00 MST
Participants: CDC Technical advisors: Sandra Barrios, Teresa Horan, Jonathan Edwards
Project Team: Lucy Savitz, Connie Price, Mike Rubin, Makoto Jones, Jason Scott, Susan Moore
The focus of this call was to review our progress report and to review the final work plan. A summary of points covered is reviewed below.
- Progress Report
- Task 4
- OMB clearance not needed for focus groups.
- Identified target meeting for focus group at the Academic Surgical Congress in February 2010.
- Task 2
- Mapping ICD-9 codes to CPT codes—Mike and Makoto are continuing to work on the mapping
- CDC would like to see the mapping when available.
- Mapping ICD-9 codes to CPT codes—Mike and Makoto are continuing to work on the mapping
- Task 1
- Monthly conference calls are set-up for the third Tuesday of every month at 12:00 MST (Next call 15 December).
- First face-to-face meeting is scheduled for Friday, 20 November at IH.
- Subcontracts with organizations are progressing.
- Task 4
- Work Plan
- Resolution matrix was included in the updated work plan to clearly specify how the research team addressed the comments and recommendations from the CDC technical experts and AHRQ TOO.
- Connie Price explained the rationale for covering herniorrhaphy (HER) over colon surgery because HER is more elective and allows for more pre-op opportunity to modify SSI risk; and many states, including Colorado, are reporting SSI cases for herniorrhaphy; further, it allows us to examine a relatively common and often outpatient surgery.
- Sandra Barrios questioned the timing of the focus groups and validating the risk factors.
- Lucy will revise the work plan to clarify the timing and relationship of the tasks.
Next meeting: 15 December 2009, 12:00 MST
Monthly Teleconference
Tuesday, 15 December 2009; 12:00 MST
- Clarification of the list of risk factors
- The list should include all risk factors—modifiable and non-modifiable
Overall Project Status update
- Task 2
- Review of ICD-9 and CPT codes to complete mapping.
- In the process of forming a data dictionary.
- Working with Scott Evans to identify data elements from IH algorithm.
- SLCVAH has received approval from the VA security officer to participate as planned.
- Task 3
- A timeline is being created and reviewed to facilitate the steps necessary leading-up to the focus groups.
- In review of the initial list of risk facts from Walt Biffl, Scott Evans has added an "EMR" column to indicate of it is currently available in the EMR; and he has added a �Define� column to indicate the need to clarify the definition of the risk factor.
- Literature search from 2008 - current was conducted-
- PubMed keyword search: "SSI risk factors"
- Scott is compiling a list of additional risk factors based on a review of abstracts defining and listing SSI risk factors.
- Task 4
- Walt Biffl is planning the focus group to include 10-12 surgeons at the Academic Surgical Congress, in February.
- The focus group will review current accepted risk stratification models and review the list of new risk factors.
- The group will evaluation additional risk factors not in the list and provide feedback relevant to the factors being modifiable vs. non- modifiable.
- Walt Biffl is planning the focus group to include 10-12 surgeons at the Academic Surgical Congress, in February.
- Task 1/5
- During the meeting at IH, the group review and coordinated the responsibilities across the organizations.
Action item
The CDC/AHRQ team requested a contact list of individuals involved in the project.
- Susan and Jason will coordinate and distribute the complete list to the CDC/AHRQ team.
Monthly Teleconference
Tuesday, 19 January 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introductions
Overall Project Status update
- Task 2
- Review of the algorithm prototype and data dictionary.
- Task 3
- The list of identified risk factors is being reviewed and will begin review by each organization to determine availability in EMR.
- Task 4
- A room for the focus group has been reserved and 4 participants are currently confirmed.
- Susan and Lucy are preparing a guide for the focus group.
- Task 1/5 - Administrative
Other items?
Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST
*agenda and any reference materials will be sent on 12 February 2010 due to Presidents� Day holiday on 15 February 2010
Monthly Teleconference
Tuesday, 19 January 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Participants: AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Teresa Horan
Project Team: Lucy Savitz, Connie Price, Mike Rubin, Makoto Jones, Jason Scott, Susan Moore, Scott Evans, Russ Staheli
Overall Project Status update
- Task 2
- Makoto reviewed the algorithm prototype and data dictionary
- The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.
- The plan is to progress with the current algorithm for a test set then review the gaps and look at other work to pick-up any events initially missed.
- The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.
- Makoto reviewed the algorithm prototype and data dictionary
- Task 3
- The list of identified risk factors is to include all factors-including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR
- Each organization is beginning review of the list of risk factors and will have EMR availability results to the group by 5 February 2010.
- The list of identified risk factors is to include all factors-including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR
- Task 4
- A room for the focus group has been reserved and 4 participants are currently confirmed
- The CDC/AHRQ team requested a list of specialties of the focus group participants
- Once all participants for the focus group have been confirmed, Susan will compile and submit this information.
- Susan and Lucy are preparing a guide for the focus group.
- A focus group of OR nurses is being planned at Intermountain Healthcare.
- Plan is submitted for expedited IRB review.
- The CDC/AHRQ team requested a list of specialties of the focus group participants
- A room for the focus group has been reserved and 4 participants are currently confirmed
- Task 1/5 � Administrative
- Subcontract between Denver Health and SLCVAH is complete.
- Subcontract between Denver Health and Intermountain Healthcare is near complete.
- Intermountain Healthcare is working to get Privacy Board approval for use of de-identified data.
- SLCVAH has received Privacy Board approval for use of de-identified data.
Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST
*agenda and any reference materials will be sent on 12 February 2010 due to Presidents� Day holiday on 15 February 2010
Monthly Teleconference
Tuesday, 16 March 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introduction
Overall Project Status update
- Task 2
- Review of updated algorithm and process to begin testing.
- Task 3
- Progress update of risk factor organization review.
- Task 4
- Follow-up discussion of focus group.
- Focus group summary.
- Task 1/5
- Administrative.
Additional items, questions/concerns, or comments.
Next call:
20 April, 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 April 2010
Monthly Teleconference
Tuesday, 16 March 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Sandra Barrios
Project Team: Lucy Savitz, Susan Moore, Mike Rubin, Walt Biffl, Scott Evans, Jason Scott
Overall Project Status update
- Task 2
- Review of updated algorithm and process to begin testing
- Data collection phase will begin at Salt Lake City VA and Intermountain Healthcare immediately following IRB approval.
- NSQIP data will be used initially to train the algorithm and test availability.
- Following initial training and testing at Salt Lake City VA and Intermountain Healthcare, the algorithm is expected to undergo adjustments based on data results before system wide testing.
- Data collection phase will begin at Salt Lake City VA and Intermountain Healthcare immediately following IRB approval.
- Review of updated algorithm and process to begin testing
- Task 3
- Progress update of risk factor organization review
- The list of common risk factors and availability is near complete and will be distributed immediately following completion.
- Progress update of risk factor organization review
- Task 4
- Follow-up discussion of focus group
- Focus group summary
- The draft Provisional Content Analysis of the focus group was reviewed.
- Although the inclusion of nonmodifiable factors was considered "inappropriate" by the focus group, nonmodifiable factors will be included for testing.
- The concern of nonmodifiable factors is a point of comment, not exclusion.
- The ranking of risk factors includes "Feasible" criteria, which indicates the ability to access the data electronically; while "Feasible, Difficult" would require manual review to obtain the data.
- The lower ranking factors are not criteria for exclusion from testing. All identified risk factors will be tested in the algorithm.
- Based on preliminary review, Sandra indicated no apparent omission from the list of risk factors
- Sandra will review the list with Teresa and Jonathan and communicate any concerns to the group.
- Although the inclusion of nonmodifiable factors was considered "inappropriate" by the focus group, nonmodifiable factors will be included for testing.
- The draft Provisional Content Analysis of the focus group was reviewed.
- Task 1/5
- Administrative
- All sub contracts are complete.
- Administrative
______________________________
Next call:
20 April, 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 April 2010
Monthly Teleconference
Tuesday, 20 April 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introduction
Overall Project Status update
- Task 2
- Review of process to begin algorithm testing and training.
- Task 3
- Review if master risk factor list.
- Review of process for writing program to collect and pool data.
- Task 4
- Focus group content analysis update.
- Task 1/5
- Administrative.
Additional items, questions/concerns, or comments.
Next call:
18 May 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 May 2010
Monthly Teleconference
Tuesday, 20 April 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Jonathan Edwards, Teresa Horan
Project Team: Susan Moore, Mike Rubin, Scott Evans, Connie Price, Jason Scott
Overall Project Status update
- Task 2
- Review of process to begin algorithm testing and training
- Collecting VA data (NSQIP) will begin data collection with IH immediately following IRB approval from IH.
- Review of process to begin algorithm testing and training
- Task 3
- Review if master risk factor list
- Master risk factor list is complete.
- All variables identified as "depends on definition" are being defined by ICD-9 definitions.
- Review of process for writing program to collect and pool data
- Meeting with Risk Adjustment Group is being planned for May 18
- Will develop spreadsheet for each site to use.
- Make sure to differentiate between not knowing, and not having the factors available ("0")
- Request to include Jonathan in the Risk adjustment Group meeting via telephone for the May 18 meeting
- Jason will send meeting information/call-in information to Jonathan.
- Will develop spreadsheet for each site to use.
- Meeting with Risk Adjustment Group is being planned for May 18
- Review if master risk factor list
- Task 4
- Focus group content analysis update.
- Finishing content analysis.
- Focus group content analysis update.
- Task 1/5
- Administrative
- Subcontracts are finalized.
- Billing process for IH and SLCVA are in progress.
- Administrative
Next call:
18 May 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 May 2010
Monthly Teleconference
Tuesday, 18 May 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introduction
Overall Project Status update
- Task 2
- Review of algorithm testing and training
- Task 3
- Review and update of master risk factor list.
- Review of program development to collect and pool data.
- Risk adjustment meeting
- Today; 15:00 (Eastern), 13:00 (Mountain).
- Task 4
- Focus group content analysis update.
- Task 1/5
- Administrative.
Additional items, questions/concerns, or comments.
Next call:
15 June 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 11 June 2010
Monthly Teleconference
Tuesday, 18 May 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees: AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Jonathan Edwards, Teresa Horan
Project Team: Lucy Savitz, Walt Biffl, Susan Moore, Mike Rubin, Scott Evans, Connie Price, Jason Scott
Overall Project Status update
- Task 2
- Review of algorithm testing and training.
- Task 3
- Review and update of master risk factor list
- Coding for procedures
- ICD-9:
- for each admit—store primary code.
- Use of decimals in the code?
- Decimals should be included
- Each organization will verify use of decimals in EMR
- Decimals should be included
- Duration of Surgery factor is measured in minutes from incision to closure.
- ICD-9:
- Coding for procedures
- Review of program development to collect and pool data
- Scott is working on a common spreadsheet template for each organization to record the data
- Each row of the spreadsheet will record a separate surgery.
- Each organization will look at the common risk factors.
- There will also be a sub analysis of all the risk factors available at Intermountain Healthcare.
- Kendall requested a list of variables unique to each organization.
- Scott is working on a common spreadsheet template for each organization to record the data
- Risk adjustment meeting
- Today; 15:00 (Eastern), 13:00 (Mountain)
- Review and update of master risk factor list
- Task 4
- Focus group content analysis update
- Susan and Walt have finished review of provisional analysis
- No follow-up items determined.
- Final review will be available at next meeting.
- Susan and Walt have finished review of provisional analysis
- Focus group content analysis update
Action Items:
- Complete list of all variables unique to each organization.
Next call:
15 June 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 11 June 2010
Monthly Teleconference
Tuesday, 15 June 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introduction
Overall Project Status update
- Task 3
- Review risk adjustment meeting
- Updated master risk factor list
- Task 4
- Meeting held to review final themes of surgeon focus group
- Task 1/5
- Administrative
Additional items, questions/concerns, or comments.
Next call:
20 July 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 July 2010
Monthly Teleconference
Tuesday, 15 June 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Jonathan Edwards
Project Team: Susan Moore, Mike Rubin, Scott Evans, Connie Price, Jason Scott
Introduction
Overall Project Status update
- Task 3
- Review risk adjustment meeting
- Handling of missing variables
- Once frequencies are available the need to impute values will be determined.
- Multiple procedures for the same patient will be included
- Handling of missing variables
- Updated master risk factor list
- Anemia
- The inclusion of the measured value of hemoglobin will be more useful than a yes/no value of anemia
- yes/no anemia values can be derived from the measured values based on set criteria to be used in the analyses of SSI risk factors.
- Check with Walt regarding the inclusion of preop and postop hemoglobin levels.
- The inclusion of the measured value of hemoglobin will be more useful than a yes/no value of anemia
- DVT
- Measure of DVT can determine the use of anticoagulants which contributes to the risk of hematoma.
- Check with Walt regarding the inclusion of DVT as a measure of SSI risk factors.
- Antibiotics
- Measure of antibiotic use should be broken into two factors
- Preop antibiotic use
- Preop antibiotic DC timing
- Cardiac surgeries have DC time of 48 hrs.
- All other surgeries have DC time of 24 hrs.
- Measure of antibiotic use should be broken into two factors
- Anemia
- Review risk adjustment meeting
- Task 4
- Meeting held to review final themes of surgeon focus group
- The final content analysis is being completed and will be available before the next call.
- Meeting held to review final themes of surgeon focus group
- Task 1/5
- Administrative
- IRB & Privacy Board review are continuing at Intermountain and Denver.
- Administrative
Additional items, questions/concerns, or comments.
Next call:
20 July 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 16 July 2010
Monthly Teleconference
Tuesday, 20 July 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introduction
Overall Project Status update
- Task 3
- Review of data collection process for common risk factors.
- Outstanding items discussion.
- Task 4
- Final content analysis of surgeon focus group
- Task 1/5
- Administrative
Additional items, questions/concerns, or comments.
Next call:
17 August 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 13 August 2010
Monthly Teleconference
Tuesday, 20 July 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Teresa Horan
Project Team: Susan Moore, Lucy Savitz, Scott Evans, Connie Price, Jason Scott
Introduction
Overall Project Status update
- Task 2
- Gold standard question
- Testing the electronic algorithm against the NSQIP dataset.
- The rigor of the surveillance with NSQIP is more complete than the collection at most sites.
- Tested at SLCVAMC and Intermountain
- Intermountain only collects on one procedure
- Tested at SLCVAMC and Intermountain
- The rigor of the surveillance with NSQIP is more complete than the collection at most sites.
- Options
- Use national VA data
- Not diverse population
- Difficult to get permission to use national data
- Use of VA NSQIP and IH data
- Use national VA data
- Any concerns with using IP collected data
- If the algorithm is being designed to replace the typical IP system, it should be to base it off of typical IP collection.
- It can be validated against the different systems and verify against NSQIP (SLCVAMC) and Intermountain.
- Subset analysis of perioperative deep wound/organ space infections
- Testing the electronic algorithm against the NSQIP dataset.
- Gold standard question
- Task 3
- Review of data collection process for common risk factors
- IH has reviewed all common risk factors and identified several elements that could be problematic to collect reliably.
- IH has completed provisional analyses of ~ 20,000 patients
- Denver has begun collection of data and will report with any trouble elements.
- IH has reviewed all common risk factors and identified several elements that could be problematic to collect reliably.
- Outstanding items discussion
- Postop hemoglobin has been added to the risk factor list
- Abx dx - 48 for CABG, and 24 for all others
- need to add into risk factors table
- Hypocholesterolemia "TYPO? Instead of Hyper?"
- Hypocholesterolemia was determined as a risk factor by the surgeon focus group as an indication of poor wound healing
- Anemia-follow-up on collection of value-the collection of the value is possible instead of just a yes/no.
- Review of data collection process for common risk factors
- Task 4
- Final content analysis of surgeon focus group
- The usefulness of the focus group outcomes:
- The process of the focus group can be considered and discussed in the final report
- Validity check
- Engaging the surgeon group
- Capturing factors the team may not have considered.
- The process of the focus group can be considered and discussed in the final report
- The usefulness of the focus group outcomes:
- Final content analysis of surgeon focus group
- Task 1/5
- Administrative
- IRB & Privacy Board approval pending at Denver and Intermountain
- Administrative
Additional items, questions/concerns, or comments.
Next call:
17 August 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 13 August 2010
--There may be a potential conflict with this call.
Sandra and Teresa will check their schedules and contact Susan to reschedule if necessary
Monthly Teleconference
Tuesday, 21 September 2010 - 13:00 EST; 11:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introduction
Overall Project Status update
- Task 2
- Salt Lake City VA has the data to begin creating the rules for the algorithm.
- Task 3
- Data collection is taking place within each organization
- Task 4
- Task 1/5
- In-person team meeting scheduled
- 15 October 2010 in Salt Lake City
- Project officer invite to participate via videoconference.
- 15 October 2010 in Salt Lake City
- In-person team meeting scheduled
Additional items, questions/concerns, or comments.
Next call:
17 August 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 13 August 2010
Monthly Teleconference
Tuesday, 21 September 2010 - 13:00 EST; 11:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Teresa Horan
Project Team: Lucy Savitz, Susan Moore, Scott Evans, Jef Huntington, Makoto Jones, Pat Nechodom, Jason Scott
Introduction
Overall Project Status update
- Task 2
- Salt Lake City VA has the data to begin creating the rules for the algorithm.
- NSQIP data will be used to train the algorithm with older data and tested with newer data
- IRB has been approved for expanded VA data
- Task 2 team meeting is scheduled for October 4th.
- Salt Lake City VA has the data to begin creating the rules for the algorithm.
- Task 3
- Data collection is taking place within each organization
- All variables have been finalized
- Intermountain has collected data and is preparing for analysis
- All organizations are in the process of collecting data
- Collected data will be sent to Jeff Huntington at Intermountain
- Susan will follow up with Connie to get data collection progress from Vail.
- Data collection is taking place within each organization
- Task 1/5
- In-person team meeting scheduled
- 15 October 2010 in Salt Lake City
- Project officer and technical advisors are invited to participate via videoconference or telephone from 3:00 - 4:00 PM EST
- Susan will send invitations to the project officer and technical advisors for participation mode (video or telephone).
- Project officer and technical advisors are invited to participate via videoconference or telephone from 3:00 - 4:00 PM EST
- 15 October 2010 in Salt Lake City
- In-person team meeting scheduled
Next call:
19 October 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 18 October 2010
Monthly Teleconference
Tuesday, 30 November 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Proposed Agenda
Introduction
Overall Project Status update
- Task 2
- NSQIP data collection at Salt Lake City VA Medical Center-including national VA NSQIP data
- Task 3
- Program development and data analysis at Intermountain
- Data collection at other systems
- Development of table to indicate where each system had the data for each risk factor.
- Task 4
- Repurposed nursing focus group to present use cases for response.
- Denver (Mile High APIC)
- Salt Lake City
- Repurposed nursing focus group to present use cases for response.
- Task 1/5
- Final in-person team meeting scheduled for 28 January 2011 in Vail, Colorado
Additional items, questions/concerns, or comments.
Next call:
21 December 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 17 December 2010
Monthly Teleconference
Tuesday, 30 November 2010 - 14:00 EST; 12:00 MST
Call-in number: 866-266-7337; code: 489038#
Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Teresa Horan, Sandra Barrios, Jonathan Edwards
Project Team: Lucy Savitz, Susan Moore, Connie Price, Heather Gilmartin, Jef Huntington, Makoto Jones, Jason Scott
Introduction
Overall Project Status update
- Task 2
- NSQIP data collection at Salt Lake City VA Medical Center-including national VA NSQIP data
- All data (local and national VA NSQIP) has been collected
- Analysis has begun
- There are some discrepancies with the start dates of the data
- SLC VA is working to clean the data
- Algorithm is in the development process
- National projection
- Numbers are small with about 20 total outcomes from documented SSI events
- There was a discussion of strength of national projections based on the population mix of the VA data as well as the small numbers
- The measures will be validated using SLC VA data as well as Intermountain data from all hospitals
- The projections, with validation, are expected to accurately represent regional projections, and with the inclusion of national VA data have national validity
- There are some discrepancies with the start dates of the data
- NSQIP data collection at Salt Lake City VA Medical Center-including national VA NSQIP data
- Task 3
- Data collection at other systems
- Denver Health is completing the data collection
- There are a few elements that have been difficult to collect, and a meeting is set up within Denver Health to complete the collection of the remaining elements
- Vail has begun collection and will complete the pull following the collection at Denver Health and Intermountain
- SLC VA has pulled all data elements
- Denver Health is completing the data collection
- Data collection at other systems
- Task 4
- Repurposed nursing focus group to present use cases for response to be held at Denver (Mile High APIC) and Salt Lake City.
- 1st draft of focus group protocol is complete and will be included in the December report
- A meeting with Intermountain and Denver Health is planned to review the draft.
- The focus group dates have not yet been set
- The results of the data analyses of the project are expected to be presented at the focus groups
- Once data analysis is complete, focus group dates will be set�likely in February.
- The results of the data analyses of the project are expected to be presented at the focus groups
- An abstract has been submitted to SHEA
- The abstract will be sent the AHRQ & CDC in the next monthly report.
- No cost extension is likely denied
- Meeting attendance as a part of dissemination may not be possible as part of the project.
- Susan will inquire about the possibility of registering for conferences prior to the end of the contract.
- 1st draft of focus group protocol is complete and will be included in the December report
- Repurposed nursing focus group to present use cases for response to be held at Denver (Mile High APIC) and Salt Lake City.
- Task 1/5
- Final in-person team meeting scheduled for 28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
- Draft final report will be submitted by 15 February 2011.
- Final report will be submitted 11 March 2011.
- Final in-person team meeting scheduled for 28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
- Next call: 21 December 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 17 December 2010- The call may have to be rescheduled based on availability of the group.
More information to come.
Monthly Teleconference
Tuesday, 28 December 2010 - 14:00 EST; 12:00 MST
Call-in number: 866-266-7337; code: 134690#
Proposed Agenda
Introduction
Overall Project Status update
- Task 2
- National VA NSQIP data analysis.
- Algorithm development.
- Task 3
- Program development and data analysis at Intermountain.
- Development of table to indicate where each system had the data for each risk factor.
- Task 4
- Repurposed nursing focus group to present use cases for response.
- First focus group will assess and develop workflow of current SSI surveillance and the resources for process change implementation
- Second focus group will assess workflow from first group and address the resources and workflow for process change implementation.
- Both focus groups are planned to be held in January
- Denver (Mile High APIC)
- Salt Lake City
- Updates on conference presentations
- Repurposed nursing focus group to present use cases for response.
- Task 1/5
- Final in-person team meeting scheduled for 27-28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
- Draft final report will be submitted to AHRQ by 11 February 2011
- Final report will be submitted to AHRQ 11 March 2011
- Final in-person team meeting scheduled for 27-28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
Additional items, questions/concerns, or comments.
Next call:
18 January 2011; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 January 2011
Monthly Teleconference
Tuesday, 28 December 2010 - 14:00 EST; 12:00 MST
Call-in number: 866-266-7337; code: 134690#
Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Teresa Horan, Sandra Barrios
Project Team: Lucy Savitz, Susan Moore, Connie Price, Heather Gilmartin, Mike Rubin, Jason Scott
Introduction
Overall Project Status update
- Task 2
- National VA NSQIP data analysis complete
- Mike will send the results of the analysis to Susan to distribute.
- Algorithm development
- Currently working to get the data into a usable format for the algorithm
- National VA NSQIP data analysis complete
- Task 3
- Program development and data analysis at Intermountain
- The program is being developed using Intermountain and Denver Health data
- The program will be updated as data from other sites come in
- Vail is expecting to have data available early January
- SLC VA is working to finish collection
- Development of table to indicate where each system had the data for each risk factor.
- The process of data collection is being carefully documented to identify data sources as well as the decision making process to use one data source over another
- There have been no surprises from the data collection process except for the varied sources of data—which, as indicated, are being thoroughly documented.
- Program development and data analysis at Intermountain
- Task 4
- Repurposed nursing focus group to present use cases for response.
- First focus group will assess and develop workflow of current SSI surveillance and the resources for process change implementation
- A mockup flowchart will be presented for the group to respond to.
- Second focus group will assess workflow from first group and address the resources and workflow for process change implementation.
- Both focus groups are planned to be held in January
- Denver (Mile High APIC)
- Salt Lake City
- Generalizability of results
- The focus groups are expected to have representation from at least 6 different systems
- The groups will be looking at the process of an electronic surveillance tool
- The focus groups are expected to raise some interesting and useful questions about the adoption and use of the surveillance tool as well as process challenges
- First focus group will assess and develop workflow of current SSI surveillance and the resources for process change implementation
- Updates on conference presentations
- SHEA abstract was accepted
- Abstract submitted to SIS
- Susan will send both abstracts to AHRQ & CDC
- Repurposed nursing focus group to present use cases for response.
- Task 1/5
- The request has been submitted to the contracting officer to pay for dissemination including all costs associated with conference registrations, travel to conferences, journal submissions (e-journal: Implementation Science)
- The request was made to pay for such dissemination efforts prior to the end of the contract period.
- Final in-person team meeting scheduled for 27-28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.
- Jonathan expressed interest in attending the meeting
- Susan will look into reserving a room at the hotel for him and confirm with him in early January
- Jonathan expressed interest in attending the meeting
- Draft final report will be submitted to AHRQ by 11 February 2011
- The report has been outlined and sections have been assigned.
- Sections will be completed mid-January
- The sections will be integrated to be worked on at the January 27-28 meeting
- A �Lessons Learned� section will be included in the report
- Final report will be submitted to AHRQ 11 March 2011
- The request has been submitted to the contracting officer to pay for dissemination including all costs associated with conference registrations, travel to conferences, journal submissions (e-journal: Implementation Science)
Next call:
18 January 2011; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 14 January 2011
Monthly Teleconference
Tuesday, 19 January 2010 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Participants:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisors: Sandra Barrios, Teresa Horan
Project Team: Lucy Savitz, Connie Price, Mike Rubin, Makoto Jones, Jason Scott, Susan Moore, Scott Evans, Russ Staheli
Overall Project Status update
- Task 2
- Makoto reviewed the algorithm prototype and data dictionary
- The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.
- The plan is to progress with the current algorithm for a test set then review the gaps and look at other work to pick-up any events initially missed.
- The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.
- Makoto reviewed the algorithm prototype and data dictionary
- Task 3
- The list of identified risk factors is to include all factors—including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR
- Each organization is beginning review of the list of risk factors and will have EMR availability results to the group by 5 February 2010.
- The list of identified risk factors is to include all factors—including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR
- Task 4
- A room for the focus group has been reserved and 4 participants are currently confirmed
- The CDC/AHRQ team requested a list of specialties of the focus group participants
- Once all participants for the focus group have been confirmed, Susan will compile and submit this information.
- Susan and Lucy are preparing a guide for the focus group
- A focus group of OR nurses is being planned at Intermountain Healthcare
- Plan is submitted for expedited IRB review
- The CDC/AHRQ team requested a list of specialties of the focus group participants
- A room for the focus group has been reserved and 4 participants are currently confirmed
- Task 1/5 - Administrative
- Subcontract between Denver Health and SLCVAH is complete.
- Subcontract between Denver Health and Intermountain Healthcare is near complete.
- Intermountain Healthcare is working to get Privacy Board approval for use of de-identified data.
- SLCVAH has received Privacy Board approval for use of de-identified data.
Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST
*agenda and any reference materials will be sent on 12 February 2010 due to Presidents' Day holiday on 15 February 2010
Monthly Teleconference
Monday, 31 January 2011 - 10:00 EST; 8:00 MST
Call-in number: 888-342-6631; code: 2414#
Meeting Notes
Attendees:
AHRQ Task Order Officer: Kendall Hall
CDC technical advisor: Sandra Barrios
Project Team: Lucy Savitz, Susan Moore, Scott Evans, Connie Price, Mike Rubin, Makoto Jones, Jef Huntington, Jason Scott
Overall Project Status update
- Task 2
- Algorithm training
- National VA NSQIP data is being used to identify the small set of electronically available variables that contribute most to the detection of SSI using recursive partitioning.
- A hybrid system is planned�to use the algorithm as a surveillance tool to trigger reduced burden of manual review by ICPs
- Deep tissue & organ space surveillance vs inclusion of superficial infections
- It was proposed to focus the algorithm on deep tissue and organ space infection to increase the sensitivity and minimize false positives of the surveillance tool.
- The algorithm is still expected to pick up some superficial infections, but the tool would be honed to pick up the more clinically relevant complex infections.
- Sandra asked if CABG is divided into sternal and harvest subgroups as superficial infections are more common in harvest procedures.
- The data will be evaluated to look at sternal vs harvest CABG.
- Sandra asked if burden estimates can be evaluated to look at the algorithm with all SSI inclusions vs just complex
- We need to document what is lost by tuning the algorithm to deep wound and organ space infections
- Estimates will be evaluated and included in the final report.
- Kendall asked for a flowchart of the algorithm
- Mike and Makoto will provide the flowchart, which is generated via the classification tree, and these will be included in the final report as an appendix
- Determination of burden to implement the algorithm at different sites
- Each site is documenting the set up and implementation process costs.
- We expect these to be minimal.
- National VA NSQIP data is being used to identify the small set of electronically available variables that contribute most to the detection of SSI using recursive partitioning.
- Algorithm training
- Task 3
- The data from all systems is being incorporated and used to identify key risk factors.
- Task 4
- Repurposed nursing focus group to present use cases for response.
- Focus groups have been exempted by the Intermountain IRB and from OMB clearance review (as the two nursing focus group protocols are distinct and in compliance with OMB rules).
- Denver—Wednesday, 2 February 2011
- Getting ICPs from at least 4 systems in the area to explore issues around adoption of the surveillance tool
- Salt Lake City--TBD
- ICPs for multiple systems will explore issues around implementation of the surveillance tool
- Lucy is working to recruit participants for the 2nd focus group, which is intended to iteratively follow focus group 1 (results from group 1 inform discussion in group 2)
- Denver—Wednesday, 2 February 2011
- The outputs of the focus groups will be used to create a user manual and include at least 2 use cases.
- Focus groups have been exempted by the Intermountain IRB and from OMB clearance review (as the two nursing focus group protocols are distinct and in compliance with OMB rules).
- Repurposed nursing focus group to present use cases for response.
- Task 5
- Draft final report will be delivered electronically by 11 February 2011
- The report will be in Word format and the appendices will be PDFs
- The draft report will also be submitted through ARRS
- Updates on conference presentations/dissemination.
- Kendall submitted a dissemination plan to include attendance and presentation at SHEA, SIS, Academy Health, and the AHRQ Annual Meeting. Publications were also included in the plan.
- Discussion of sustained tool implementation and development
- Sandra discussed the importance of making sure the tool is viewed by adopting systems to be dynamic (vs. static)) continually evolving and will QI/QA with continuing feedback to support improvement and continued applicability of the tool.
- Kendall asked how we plan to keep a feedback loop.
- Feedback recommendations will be made in the report
- Denver Health is planning to use the tool and modify it to include other surgeries.
- Adoption at SLC VAMC would likely show applicability in VAs nationwide�Mike will explore a connection with the VA National Center for Patient Safety as suggested by Kendalll
- Lucy will connect with the AHRQ Health Care Innovations Exchange to explore how we might monitor and track uptake.
- Draft final report will be delivered electronically by 11 February 2011
- Task 1
- The call scheduled on 15 February 2011 was proposed to be postponed one week to allow time for AHRQ & CDC to provide feedback from the draft report
- Susan will poll the group to reschedule the call
- Invoicing
- Systems are working with their accounting departments for updated invoices and final invoicing to be submitted on time.
- The call scheduled on 15 February 2011 was proposed to be postponed one week to allow time for AHRQ & CDC to provide feedback from the draft report
Next call: To be determined, on or about 2/22/11. Susan will get dates and times to reschedule
Monthly Teleconference
Tuesday 15 March 2011 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees:
AHRQ: Kendall Hall
CDC: Teresa Horan, Sandra Barrios Jonathan Edwards
Project Team: Susan Moore, Lucy Savitz, Jason Scott, Jef Huntington, Mike Rubin, Makoto Jones, Connie Price, Walt Biffl, Heather Gilmartin
- General project updates
- No cost extension granted through October 2011 for dissemination
- Project work planed to be finished in April
- The algorithm is being run at each site multiple times
- Specificity is very low (many false negatives)
- Doing extensive chart reviews to learn more about the e surveillance
- Looking for elements that were not picked-up, but present in charts (specifically false negatives)
- Determine factors leading to false negatives
- Task three work is continuing and will use additional time for QA of code
- Task 4: focus groups complete.
- Generating a universal user manual
- No cost extension granted through October 2011 for dissemination
- Dissemination plans
- AMIA-abstract due 17 February
- What should be submitted to AHRQ and CDC prior to dissemination?
- AHRQ and CDC would like to review abstracts for dissemination activities
- Additional items
- Connie and Jonathan with arrange time at the SHEA meeting to have a group discussion
- Will include a detailed review of the algorithm development process.
- Connie and Jonathan with arrange time at the SHEA meeting to have a group discussion
Monthly Teleconference
Tuesday 19 April 2011 - 14:00 EST; 12:00 MST
Call-in number: 888-342-6631; code: 2414#
Notes
Attendees:
AHRQ: Kendall Hall
CDC: Teresa Horan, Jonathan Edwards
Project Team: Susan Moore, Lucy Savitz, Jason Scott, Jef Huntington, Scott Evans, Mike Rubin, Connie Price, Walt Biffl
- General project status review
- Task 2 - Algorithm testing and site chart reviews
- Details of the algorithm development were reviewed at SHEA meeting.
- Chart reviews are done at SLCVAMC and Denver Health-Intermountain chart reviews will be completed following template update based on Denver Health feedback.
- Issues found with data format
- Looking at where the data come from and how it was coded
- The variation in data across all systems will be an important factor to note in the final report
- Issues found with data format
- Task 3 - data analyses update
- Code has been verified and will run data (including SLC VAMC) by the end of the week
- Scott write up report
- Code has been verified and will run data (including SLC VAMC) by the end of the week
- Task 2 - Algorithm testing and site chart reviews
- Additional items
- User manual—pulling documentation across all tasks to inform the manual
- Data from nursing focus groups will be included in the next monthly report
- Final report is being updated based on new work as it comes along
- Extending the work to other surgeries eg, colon, hysterectomy
- The work could not be an extension of this contract as it is a change in the scope of the work—it will require an add-on of an additional project.
- Kendall will discuss this question at AHRQ and gauge feasibility of an add-on project
- Teresa will talk to Sandra about possibility of support from CDC
- The work could not be an extension of this contract as it is a change in the scope of the work—it will require an add-on of an additional project.
