Person: Yokoe, Deborah S.
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Yokoe
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Deborah S.
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Yokoe, Deborah S.
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Publication Erratum to: Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI’s Project JOINTS(BioMed Central, 2017) Schneider, Eric; Sorbero, Melony E.; Haas, Ann; Ridgely, M. Susan; Khodyakov, Dmitry; Setodji, Claude M.; Parry, Gareth; Huang, Susan S.; Yokoe, Deborah S.; Goldmann, DonPublication Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the Institute for Health Improvement’s Project JOINTS(BioMed Central, 2017) Schneider, Eric; Sorbero, Melony E.; Haas, Ann; Ridgely, M. Susan; Khodyakov, Dmitry; Setodji, Claude M.; Parry, Gareth; Huang, Susan S.; Yokoe, Deborah S.; Goldmann, DonBackground: A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach. Methods: Project JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement. We conducted a cluster-randomized trial including ten states (five campaign states and five non-campaign states) with 188 hospitals providing joint replacement to Medicare. We measured adherence to the evidence-based practices before and after the campaign using a survey of surgical staff and a difference-in-difference design with multivariable adjustment to compare adherence to each of the relevant practices and an all-or-none composite measure of the three new practices. Results: In the campaign states, there were statistically significant increases in adherence to the three new evidence-based practices promoted by the campaign. Compared to the non-campaign states, the relative increase in adherence to the three new practices in the campaign states ranged between 1.9 and 15.9 percentage points, but only one of these changes (pre-operative nasal screening for Staphylococcus aureus carriage and decolonization prior to surgery) was statistically significant (p < 0.05). On the all-or-none composite measure, adherence to all three evidence-based practices increased from 19.6 to 37.9% in the campaign states, but declined slightly in the comparison states, yielding a relative increase of 23 percentage points (p = 0.004). In the non-campaign states, changes in adherence were not statistically significant. Conclusions: Within 6 months, in a cluster-randomized trial, a multi-state campaign targeting hospitals and professionals involved in surgical care and infection control was associated with an increase in adherence to evidence-based practices that can reduce surgical site infection. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0579-7) contains supplementary material, which is available to authorized users.Publication Surgical Site Infections: Volume-Outcome Relationship and Year-to-Year Stability of Performance Rankings(Lippincott Williams & Wilkins, 2017) Calderwood, Michael S.; Kleinman, Ken; Huang, Susan S.; Murphy, Michael; Yokoe, Deborah S.; Platt, RichardBackground: Surgical site infection (SSI) rates are publicly reported as quality metrics and increasingly used to determine financial reimbursement. Objective: To evaluate the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. Research Design: We performed a retrospective cohort study of Medicare beneficiaries who underwent CABG surgery or hip arthroplasty at US hospitals from 2005 to 2011, with outcomes analyzed through March 2012. Nationally validated claims-based surveillance methods were used to assess for SSI within 90 days of surgery. The relationship between procedure volume and SSI rate was assessed using logistic regression and generalized additive modeling. Year-to-year stability of SSI rates was evaluated using logistic regression to assess hospitals’ movement in and out of performance rankings linked to financial penalties. Results: Case-mix adjusted SSI risk based on claims was highest in hospitals performing <50 CABG/year and <200 hip arthroplasty/year compared with hospitals performing ≥200 procedures/year. At that same time, hospitals in the worst quartile in a given year based on claims had a low probability of remaining in that quartile the following year. This probability increased with volume, and when using 2 years’ experience, but the highest probabilities were only 0.59 for CABG (95% confidence interval, 0.52–0.66) and 0.48 for hip arthroplasty (95% confidence interval, 0.42–0.55). Conclusions: Aggregate SSI risk is highest in hospitals with low annual procedure volumes, yet these hospitals are currently excluded from quality reporting. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance.Publication Pharmacy Data for Tuberculosis Surveillance and Assessment of Patient Management(Centers for Disease Control and Prevention, 2004) Coon, Steven W.; Dokholyan, Rachel; Iannuzzi, Michael C.; Meredith, Sarah; Moore, Marisa; Phillips, Lynelle; Ray, Wayne; Schech, Stephanie; Shatin, Deborah; Yokoe, Deborah S.; Jones, Timothy F.; Platt, RichardUnderreporting tuberculosis (TB) cases can compromise surveillance. We evaluated the contribution of pharmacy data in three different managed-care settings and geographic areas. Persons with more than two anti-TB medications were identified by using pharmacy databases. Active TB was confirmed by using state TB registries, medical record review, or questionnaires from prescribing physicians. We identified 207 active TB cases, including 13 (6%) missed by traditional surveillance. Pharmacy screening identified 80% of persons with TB who had received their medications through health plan–reimbursed sources, but missed those treated solely in public health clinics. The positive predictive value of receiving more than two anti-TB medications was 33%. Pharmacy data also provided useful information about physicians’ management of TB and patients’ adherence to prescribed therapy. Pharmacy data can help public health officials to find TB cases and assess their management in populations that receive care in the private sector.Publication Enhanced Identification of Postoperative Infections among Inpatients(Centers for Disease Control and Prevention, 2004) Noskin, Gary A.; Cunningham, Susan M.; Plaskett, Theresa; Fraser, Victoria J.; Olsen, Margaret A.; Tokars, Jerome I.; Solomon, Steven; Perl, Trish M.; Cosgrove, Sara E.; Tilson, Richard S.; Greenbaum, Maurice; Herwaldt, Loreen A.; Diekema, Daniel J.; Climo, Michael; Yokoe, Deborah S.; Zuccotti, Gianna; Hooper, David; Sands, Kenneth; Tully, John Lawrence; Wong, Edward S.; Platt, RichardWe evaluated antimicrobial exposure, discharge diagnoses, or both to identify surgical site infections (SSI). This retrospective cohort study in 13 hospitals involved weighted, random samples of records from 8,739 coronary artery bypass graft (CABG) procedures, 7,399 cesarean deliveries, and 6,175 breast procedures. We compared routine surveillance to detection through inpatient antimicrobial exposure (>9 days for CABG, >2 days for cesareans, and >6 days for breast procedures), discharge diagnoses, or both. Together, all methods identified SSI after 7.4% of CABG, 5.0% of cesareans, and 2.0% of breast procedures. Antimicrobial exposure had the highest sensitivity, 88%–91%, compared with routine surveillance, 38%–64%. Diagnosis codes improved sensitivity of detection of antimicrobial exposure after cesareans. Record review confirmed SSI after 31% to 38% of procedures that met antimicrobial surveillance criteria. Sufficient antimicrobial exposure days, together with diagnosis codes for cesareans, identified more postoperative SSI than routine surveillance methods. This screening method was efficient, readily standardized, and suitable for most hospitals.Publication Enhanced Identification of Postoperative Infections among Outpatients(Centers for Disease Control and Prevention, 2004) Miner, Andrew L.; Sands, Kenneth; Yokoe, Deborah S.; Freedman, John; Thompson, Kristin; Livingston, James Michael; Platt, RichardWe investigated using administrative claims data to identify surgical site infections (SSI) after breast surgery and cesarean section. Postoperative diagnosis codes, procedure codes, and pharmacy information were automatically scanned and used to identify claims suggestive of SSI (“indicators”) among 426 (22%) of 1,943 breast procedures and 474 (10%) of 4,859 cesarean sections. For 104 breast procedures with indicators explained in available medical records, SSI were confirmed for 37%, and some infection criteria were present for another 27%. Among 204 cesarean sections, SSI were confirmed for 40%, and some criteria were met for 27%. The extrapolated infection rates of 2.8% for breast procedures and 3.1% for cesarean section were similar to those reported by the National Nosocomial Infection Surveillance program but differ in representing predominantly outpatient infections. Claims data may complement other data sources for identification of surgical site infections following breast surgery and caesarian section.Publication Attitudes of Healthcare Workers in U.S. Hospitals Regarding Smallpox Vaccination(BioMed Central, 2003) Yih, Katherine; Lieu, Tracy; Rêgo, Virginia H; O'Brien, Megan A; Shay, David K; Yokoe, Deborah S.; Platt, RichardBackground: The United States is implementing plans to immunize 500,000 hospital-based healthcare workers against smallpox. Vaccination is voluntary, and it is unknown what factors drive vaccine acceptance. This study's aims were to estimate the proportion of workers willing to accept vaccination and to identify factors likely to influence their decisions. Methods: The survey was conducted among physicians, nurses, and others working primarily in emergency departments or intensive care units at 21 acute-care hospitals in 10 states during the two weeks before the U.S. national immunization program for healthcare workers was announced in December 2002. Of the questionnaires distributed, 1,165 were returned, for a response rate of 81%. The data were analyzed by logistic regression and were adjusted for clustering within hospital and for different number of responses per hospital, using generalized linear mixed models and SAS's NLMIXED procedure. Results: Sixty-one percent of respondents said they would definitely or probably be vaccinated, while 39% were undecided or inclined against it. Fifty-three percent rated the risk of a bioterrorist attack using smallpox in the United States in the next two years as either intermediate or high. Forty-seven percent did not feel well-informed about the risks and benefits of vaccination. Principal concerns were adverse reactions and the risk of transmitting vaccinia. In multivariate analysis, four variables were associated with willingness to be vaccinated: perceived risk of an attack, self-assessed knowledge about smallpox vaccination, self-assessed previous smallpox vaccination status, and gender. Conclusions: The success of smallpox vaccination efforts will ultimately depend on the relative weight in people's minds of the risk of vaccine adverse events compared with the risk of being exposed to the disease. Although more than half of the respondents thought the likelihood of a bioterrorist smallpox attack was intermediate or high, less than 10% of the group slated for vaccination has actually accepted it at this time. Unless new information about the threat of a smallpox attack becomes available, healthcare workers' perceptions of the vaccine's risks will likely continue to drive their ongoing decisions about smallpox vaccination.Publication Automated Methods for Surveillance of Surgical Site Infections(Centers for Disease Control, 2001) Platt, Richard; Yokoe, Deborah S.; Sands, KennethAutomated data, especially from pharmacy and administrative claims, are available for much of the U.S. population and might substantially improve both inpatient and postdischarge surveillance for surgical site infections complicating selected procedures, while reducing the resources required. Potential improvements include better sensitivity, less susceptibility to interobserver variation, more uniform availability of data, more precise estimates of infection rates, and better adjustment for patients' coexisting illness.Publication 942How Do Hospitals Detect Outbreaks?(Oxford University Press, 2014) Baker, Meghan; Huang, Susan S.; Letourneau, Alyssa; Kaganov, Rebecca E.; Peeples, Jennifer R.; Drees, Marci; Yokoe, Deborah S.