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Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty
  1. Michael S Calderwood1,
  2. Deborah S Yokoe2,
  3. Michael V Murphy3,
  4. Katherine O DeBartolo4,
  5. Kathy Duncan4,
  6. Christina Chan3,
  7. Eric C Schneider5,
  8. Gareth Parry4,
  9. Don Goldmann4,6,
  10. Susan Huang7
  1. 1 Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  2. 2 Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
  3. 3 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
  4. 4 Institute for Healthcare Improvement, Boston, Massachusetts, USA
  5. 5 The Commonwealth Fund, New York City, New York, USA
  6. 6 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  7. 7 Division of Infectious Diseases and Healthy Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, USA
  1. Correspondence to Dr Michael S Calderwood, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA; Michael.S.Calderwood{at}


Background Quality improvement (QI) campaigns appear to increase use of evidence-based practices, but their effect on health outcomes is less well studied.

Objective To assess the effect of a multistate QI campaign (Project JOINTS, Joining Organizations IN Tackling SSIs) that used the Institute for Healthcare Improvement’s Rapid Spread Network to promote adoption of evidence-based surgical site infection (SSI) prevention practices.

Methods We analysed rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention (May 2010 to April 2011) and postintervention (November 2011 to September 2013) periods in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states. We used generalised linear mixed effects models and a difference-in-differences approach to estimate changes in SSI outcomes.

Results 125 070 patients underwent hip arthroplasty in 405 hospitals in intervention states, compared with 131 787 in 525 hospitals in comparison states. 170 663 patients underwent knee arthroplasty in 397 hospitals in intervention states, compared with 196 064 in 518 hospitals in comparison states. After the campaign, patients in intervention states had a 15% lower odds of developing hip arthroplasty SSIs (OR=0.85, 95% CI 0.75 to 0.96, p=0.01) and a 12% lower odds of knee arthroplasty SSIs than patients in comparison states (OR=0.88, 95% CI 0.78 to 0.99, p=0.04).

Conclusions A larger reduction of SSI rates following hip and knee arthroplasty was shown in intervention states than in matched control states.

  • quality improvement
  • surgery
  • evidence-based medicine
  • nosocomial infections

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  • Funding This study was funded by the Agency for Healthcare Research and Quality (grant number: R18 HS021424), and the Department of Health and Human Services (grant number: R18 AE00005).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Harvard Pilgrim Health Care IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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