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## Complete Summary

#### TITLE

Perioperative care: percentage of surgical patients aged 18 years and
older undergoing procedures with the indications for a first or second
generation cephalosporin prophylactic antibiotic who had an order for
cefazolin or cefuroxime for antimicrobial prophylaxis.

#### SOURCE(S)

American College of Surgeons, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Perioperative
care physician performance measurement set. Chicago (IL): American
Medical Association, National Committee for Quality Assurance; 2006 Oct.
11 p. \[8 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of surgical patients aged
18 years and older undergoing procedures with the indications for a
first or second generation cephalosporin prophylactic antibiotic who had
an order for cefazolin or cefuroxime for antimicrobial prophylaxis.

#### RATIONALE

Current published evidence supports the use of either cefazolin, a first
generation cephalosporin, or cefuroxime, a second generation
cephalosporin, for many surgical procedures, in the absence of
Beta-lactam allergy. An alternative antimicrobial regimen may be
appropriate depending on the antimicrobial susceptibility pattern in an
individual institution (potentially a medical reason for excluding
patients treated at that institution from this measure).\*

\*The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines and
represent the evidence base for the measure:

For most procedures, cefazolin should be the agent of choice because of
its relatively long duration of action, its effectiveness against the
organisms most commonly encountered in surgery, and it\'s relatively low
cost. (American Society of Health-System Pharmacists \[ASHP\])

In operations for which cephalosporins represent appropriate
prophylaxis, alternative antimicrobials should be provided to those with
a high likelihood of serious adverse reaction or allergy on the basis of
patient history or diagnostic tests such as skin testing.

The preferred antimicrobials for prophylaxis in patients undergoing hip
or knee arthroplasty are cefazolin and cefuroxime. Vancomycin or
clindamycin may be used in patients with serious allergy or adverse
reactions to Beta-lactams.

The recommended antimicrobials for cardiothoracic and vascular
operations include cefazolin or cefuroxime. For patients with serious
allergy or adverse reaction to Beta-lactams, vancomycin is appropriate,
and clindamycin may be an acceptable alternative. (Surgical Infection
Prevention Guidelines Writers Workgroup \[SIPGWW\])

#### PRIMARY CLINICAL COMPONENT

Perioperative care; cephalosporin prophylactic antibiotic; cefazolin;
cefuroxime

#### DENOMINATOR DESCRIPTION

All surgical patients aged 18 years and older undergoing procedures with
the indications for a first OR second generation cephalosporin
prophylactic antibiotic (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Surgical patients who had an order for cefazolin OR cefuroxime for
antimicrobial prophylaxis (see the related \"Numerator
Inclusions/Exclusions\" field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance\
Variation in quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Agency for Healthcare Research and Quality (AHRQ). Making health care
safer. A critical analysis of patient safety issues \[AHRQ Publication
No. 01-E058\]. Rockville (MD): Agency for Healthcare Research and
Quality (AHRQ); 2001 Jul. 672 p.(Evidence report /technology assessment;
no. 43).

Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE,
Wright C, Ma A, Carr K, Red L. Use of antimicrobial prophylaxis for
major surgery: baseline results from the national surgical infection
prevention project. Arch Surg2005 Feb;140(2):174-82.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15724000)

Leatherman S, McCarthy D. Quality of health care for medicare
beneficiaries: a chartbook. Focusing on the elderly living in the
community. Vol. 815New York (NY): Commonwealth Fund; 2005 May. 184 p.

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All surgical patients aged 18 years and older undergoing procedures with
the indications for a first OR second generation cephalosporin
prophylactic antibiotic

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All surgical patients aged 18 years and older undergoing procedures with
the indications for a first OR second generation cephalosporin
prophylactic antibiotic

**Exclusions**\
Documentation of medical reason(s) for not ordering cefazolin OR
cefuroxime for antimicrobial prophylaxis

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Surgical patients who had an order for cefazolin OR cefuroxime for
antimicrobial prophylaxis

**Note**: There must be documentation of order (written order, verbal
order, or standing order/protocol) for cefazolin OR cefuroxime for
antimicrobial prophylaxis OR documentation that cefazolin OR cefuroxime
was *[given]{.underline}*.

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #3: selection of prophylactic antibiotic - first OR second
generation cephalosporin.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1909&doc=178)

#### MEASURE SET NAME

[Perioperative Care Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1909&doc=10256)

#### SUBMITTER

American Medical Association on behalf of the American College of
Surgeons, the National Committee for Quality Assurance, and the
Physician Consortium for Performance Improvement®

#### DEVELOPER

American College of Surgeons\
National Committee for Quality Assurance\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Ronald A. Gabel, MD (*Co-Chair*); R. Scott Jones, MD, FACS (*Co-Chair*);
Priscilla Arnold, MD; Raj Behal, MD, MPH; Dale W. Bratzler, DO, MPH;
Quentin Clemens, MD; Charles Drueck, MD, FACC; Fred Edwards, MD; Lee A.
Fleisher, MD, FACC; Alex Hannenberg, MD; Daniel L. Herr, MS, MD, FCCM;
David Hunt, MD, FACS; Kay Jewell, MD; Rahul K. Khare, MD, FACS; Shukri
F. Khuri, MD, MBA; Rick Leary, MD, MBA; Kenneth Moore, MD; Mark Morasch,
MD; Stephen Novack, DO; Frank Opelka, MD; Laura Orvidas, MD; Tom Read,
MD; Sam J.W. Romeo, MD, MBA; Jerry Shuster, MD; Carl A. Sirio, MD;
Sandra Tunajek, CRNA, ND; Patrick Voight, RN, BSN, MSA, CNOR; William
Wooden, MD

Julie Lewis, American College of Surgeons; Karen Richards, American
College of Surgeons

Mark S. Antman, DDS, MBA, American Medical Association; Karen S. Kmetik,
PhD, American Medical Association; Beth Tapper, MA, American Medical
Association; Samantha Tierney, MPH, American Medical Association

Joachim Roski, PhD, MPH, National Committee for Quality Assurance

Tom Croghan, MD; Latousha Leslie, RN, MS, Mathematica Policy Research,
Centers for Medicare & Medicaid Services; Sylvia Publ, MBA, RHIA,
Mathematica Policy Research, Centers for Medicare & Medicaid Services;
Michael Rapp, MD, Mathematica Policy Research, Centers for Medicare &
Medicaid Services

Lisa Buczkowski, RN, MS, Joint Commission on Accreditation of Healthcare
Organizations; Raquel Gabriel-Bennewitz, MS/MBA, BSN, RN, Joint
Commission on Accreditation of Healthcare Organizations

Rebecca A. Kresowik, Facilitators; Timothy F. Kresowik, MD, Facilitator

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Ambulatory Care Quality Alliance\
Physician Quality Reporting Initiative

#### ADAPTATION

This measure was harmonized to the extent possible to measures included
in the Surgical Care Improvement Project (SCIP).

#### PARENT MEASURE

Unspecified

#### RELEASE DATE

2006 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American College of Surgeons, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Perioperative
care physician performance measurement set. Chicago (IL): American
Medical Association, National Committee for Quality Assurance; 2006 Oct.
11 p. \[8 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #3: Selection of Prophylactic
Antibiotic - First OR Second Generation Cephalosporin,\" is published in
the \"Perioperative Care Physician Performance Measurement Set.\" This
document and technical specifications are available in Portable Document
Format (PDF) from the American Medical Association (AMA)-convened
Physician Consortium for Performance Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on September 13, 2007.
The information was verified by the measure developer on October 26,
2007.

#### COPYRIGHT STATEMENT

© Measures including specifications

© 2005-6 American Medical Association and National Committee for Quality
Assurance

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008