Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Context: Guideline adherence has been shown to be an effective way to improve the quality of care, especially for surgical procedures, in recent years. Surgical site infection is considered as an important indicator for the quality of surgical procedure. In Taiwan, the guideline for prophylactic antibiotics use in surgery has been introduced in 2004. No evaluation about guideline adherence and quality of care has been reported. Objectives: This study aims to examine the association between guideline adherence, medical expenditures and healthcare outcome for prophylactic antibiotics use in 3 common surgical procedures in Taiwan. Methods: This study selected 3 frequently operated surgical procedures in Taiwan: appendectomy, total hip replacement (THR) and total knee replacement (TKR). Claim data with detailed prescription orders during hospitalization were obtained from the National Health Insurance Research Databases. The guidelines for the use of prophylactic antobiotics in surgery came from the ?Infectious Diseases Society of Taiwan? and ?Taiwan Surgical Association?. The major research variables were guideline adherence, medical expenditures, length of hospitalization and suspected postoperative infection. Logistic regression and multiple regression analysis were used to explore the relationship of related variables. Results: The preliminary results for appendectomy in 2004 revealed that the overall guideline adherence rate of prophylactic antibiotics use was about 20%. A higher level of guideline adherence was associated with less medical expenditures, shorter length of stay and lower probability of postoperative infection. More comprehensive data for appendectomy, THR, TKR in 2005 and 2006 years will be obtained (in two months) for further analysis and more detailed results will be presented in the conference.