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Volume 8, Number 12—December 2002

Research

Using Automated Health Plan Data to Assess Infection Risk from Coronary Artery Bypass Surgery

Richard Platt*†‡Comments to Author , Ken Kleinman*†, Kristin Thompson*†, Rachel S. Dokholyan*†, James M. Livingston*‡, Andrew Bergman*§, John H. Mason*#, Teresa C. Horan**, Robert P. Gaynes#, Steven L. Solomon#, and Kenneth E. Sands*††
Author affiliations: *Centers for Disease Control and Prevention Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts, USA; †Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA; ‡Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; §Tufts Health Plan, Boston, Massachusetts, USA; #Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA; **Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ††Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;

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Table 1

Characteristics of the population of patients of five health-care plans in Massachusetts, January 1996–March 1999

Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 All p valuea
Procedures 161 584 635 363 210 1,953
Age (range)a 67 (61–73) 59 (53–64) 60 (54–65) 59 (53–63) 72 (68–75) 61 (55–67) <0.0001
Sex, % male 77 78 83 80 60 78 <0.0001
Prescriptions (range) during the 180 days before surgeryb 14 (9-22) 18 (10-28) 18 (12-27) 9 (6-12) 14 (7-21) 15 (9-24) 0.0001
Chronic disease score (range)b 2,474 (1,774–3,704) 2,211 (1,403– 3,456) 2,378 (1,506–3,662) 2,156 (1,372–3,350) 2,369 (1,432–3,376) 2,283 (1,446–3,511) 0.01
Prescriptions (range) during the 30 days after surgery b 5 (3–7) 6 (4–8) 4 (3–6) 5 (3–7) 3 (0–5) 5 (3–7) <0.0001
Days (range) with ambulatory care claims b 1 (1–2) 10 (7–13) 6 (3–8) 11 (8–16) 14 (10–18) 8 (5–13) 0.0001
Diagnoses on days with ambulatory claims (average) 2.6 2.6 2.2 1.9 1.5 2.2
Patients with specified indicator of infection
% (no. of patients):
Diagnosis during index hospitalization 6 (9) 3 (17) 2 (14) 2 (7) 1 (2) 3 (49) 0.05
Diagnosis in ambulatory setting (excludes emergency room) 12 (19) 15 (89) 17 (105) 11 (39) 13 (28) 14 (280) NS
Diagnosis in emergency rooms 2 (3) 3 (19) 2 (12) 2 (6) 1 (3) 2 (43) NS
Diagnosis during second hospitalization, includes extended care facilities 9 (14) 7 (41) 2 (15) 2 (6) 0 (1) 4 (77) <0.01
Antistaphylococcal antibiotic in ambulatory setting 16 (26) 18 (107) 13 (81) 14 (52) 12 (25) 15 (291) 0.05
Wound culture performed 2 (3) 2 (12) 5 (33) 6 (22) 1 (2) 4 (72) <0.01
Wound care
0 (0)
1 (4)
2 (15)
1 (5)
1 (2)
1 (26)
0.052
aKruskal-Wallis or chi-square tests of the null hypothesis of no difference between plans.
bMedian (interquartile range).

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