Administrative Memos

199904

FROM: Theodore O. Will, Chief Executive Officer
DATE: Apr 23, 1999
SUBJECT: Prolonged Use of Prophylactic Antibiotics in Medicare Elective Colorectal Surgery
IPRO CONTACTS:

Alan Silver, MD, MPH, Clinical Coordinator, ext 509
Harriet Starr, Vice President, Project Development & Evaluation, ext 527

Enclosed please find the report on "Prolonged Use of Prophylactic Antibiotics in Medicaid Elective Colorectal Surgery". This Medicaid project grew out of an earlier Health Care Quality Improvement Project (HCQIP) on surgical antibiotic prophylaxis which suggested that post-operative prophylactic antibiotic usage was common despite guidelines stating that post-operative prophylaxis was typically unneeded. A Medicare quality improvement project on this topic is currently underway, and was distributed in February 1999 as HCQIP Administrative Memorandum #99-03.

Data from all Medicaid claims discharged between April 1997 and March 1998, that met the selection criteria, were abstracted for this project. The results of this study are very similar to those found in the Medicare study, and demonstrate that prolonged use of antibiotics is prevalent. This usage can lead to adverse events, increased costs, and the growth of antibiotic-resistant organisms.

IPRO will remeasure prophylactic antibiotic usage in Medicaid patients with data from late 1999, in order to assess improvement. We urge hospitals to consider quality improvement projects examining antibiotic prophylaxis.

Please note that a hard copy slide show presentation has been appended to the report. A slide show with Medicare data may be downloaded from IPRO's website (www.ipro.org) using the Professional Connection button.

EXECUTIVE SUMMARY

IPRO's project on Prolonged Use on Prophylactic Antibiotics in Medicaid Elective Colorectal Surgery is intended to maximize the proportion of eligible patients who do not receive post-operative antibiotic prophylaxis for elective colorectal surgery. This goal is based on recent medical literature which shows that single dose prophylaxis is as effective as multiple doses in preventing surgical wound infection, and is also associated with less toxicity, fewer adverse events and lower costs.

IPRO abstracted 488 New York State Medicaid charts taken from the administrative data listing for colorectal procedures during the time period April, 1997, through March 30, 1998. In the analysis of the 210 Medicaid patients subsequently confirmed as having elective colorectal procedures for whom there was no other evidence for being on antibiotics either prior to or for the first 72 hours after surgery, IPRO found that only 16 percent had no post-surgical prophylaxis; 35 percent had antibiotics continued for up to 24 hours post-surgery; 13 percent had antibiotic usage for up to 48 hours post-surgery; and 36 percent had antibiotic usage exceeding 48 hours after surgery.

Successful improvement strategies include professional education as well as hospital system changes, including combined pharmacist/surgeon rounds.

IPRO plans to remeasure this project with data from late 1999, in order to assess improvements.