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Livingston, James Michael

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Livingston

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James Michael

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Livingston, James Michael

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2002 - 20042

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Author's Publications: search.filters.isAuthorOfPublication.c90d852e-1f4e-41d3-b2b5-af94fa531fce

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    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, Richard
    We 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.
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    Using Automated Health Plan Data to Assess Infection Risk from Coronary Artery Bypass Surgery
    (Centers for Disease Control and Prevention, 2002) Thompson, Kristin; Dokholyan, Rachel S.; Horan, Teresa C.; Gaynes, Robert P.; Solomon, Steven L.; Platt, Richard; Kleinman, Kenneth Paul; Livingston, James Michael; Bergman, Andrew; Mason, John H.; Sands, Kenneth
    We determined if infection indicators were sufficiently consistent across health plans to allow comparison of hospitals’ risks of infection after coronary artery bypass surgery. Three managed care organizations accounted for 90% of managed care in eastern Massachusetts, from October 1996 through March 1999. We searched automated inpatient and outpatient claims and outpatient pharmacy dispensing files for indicator codes suggestive of postoperative surgical site infection. We reviewed full text medical records of patients with indicator codes to confirm infection status. We compared the hospital-specific proportions of cases with an indicator code, adjusting for health plan, age, sex, and chronic disease score. A total of 536 (27%) of 1,953 patients had infection indicators. Infection was confirmed in 79 (53%) of 149 reviewed records with adequate documentation. The proportion of patients with an indicator of infection varied significantly (p<0.001) between hospitals (19% to 36%) and health plans (22% to 33%). The difference between hospitals persisted after adjustment for health plan and patients’ age and sex. Similar relationships were observed when postoperative antibiotic information was ignored. Automated claims and pharmacy data from different health plans can be used together to allow inexpensive, routine monitoring of indicators of postoperative infection, with the goal of identifying institutions that can be further evaluated to determine if risks for infection can be reduced.