Comparison of Rates Question 1 Tiffany Woods George Mason University Instructor: Farrokh Alemi, Ph.D. HAP 725

The Problem We are asked to construct a control chart showing the rate of prophylactic antibiotic overuse over time at Southeast Alabama Medical Center. Our data will come from the 2015 & 2016 datasets which contain the most recent recordings of antibiotic overuse.

Step 1: Download the data Go to https://data.medicare.gov/data/archives/hospital-compare Under the “2016 Annual Files” section, open the .zip file Hospital_Revised_FlatFiles_20161110.

You will see a .csv file called Timely and Effective Care – Hospital. *This file contains the data on antibiotic overuse. Save this file as an Excel Workbook (.xlsx) & rename it according to its date (2016-11-10) Save as “2016-11-10”

Complete these steps for the following 9 .zip files: 2016 Annual Files Hospital_Revised_FlatFiles_20161110 (2016-11-10) HOSArchive_Revised_FlatFiles_20160810.zip (2016-08-10) HOSArchive_Revised_FlatFiles_20160504.zip (2016-05-04) 2015 Annual Files HOSArchive_Revised_FlatFiles_20151210.zip (2015-12-10) HOSArchive_Revised_FlatFiles_20151008.zip (2015-10-08) HOSArchive_Revised_FlatFiles_20150716.zip (2015-07-16) HOSArchive_Revised_Flatfiles_20150506.zip (2015-05-06) HOSArchive_Revised_Flatfiles_20150416.zip (2015-04-16) HOSArchive_Revised_Flatfiles_20150122.zip (2015-01-22)

End the end, you should have 9 .xlsx files saved:

Step 2: Import the 9 .xlsx files into Microsoft SQL Server Use ‘Microsoft Excel’ as your data source In the end, you should have something similar to this: *You may want to rename each dbo according to its date, as such.

Step 3: Query the 9 tables This code selects the antibiotic overuse data (Measure ID = SCIP_INF_3) for Southeast Alabama Medical Center (Provider ID = 10001) from each table. Then, it compiles this data into a singular output using UNION. SQL Code for Comparison of Rates, Question 1 SELECT [Provider ID], [Measure ID], CAST([Measure Start Date] as DATE) as [Measure Start Date], CAST([Measure End Date] as DATE) as [Measure End Date], [Score], [Sample] FROM dbo.[2015-01-22] WHERE [Provider ID] ='10001' AND [Measure ID] = 'SCIP_INF_3'   UNION FROM dbo.[2015-04-16] FROM dbo.[2015-05-06] FROM dbo.[2015-07-16] FROM dbo.[2015-10-08] FROM dbo.[2015-12-10] FROM dbo.[2016-05-04] FROM dbo.[2016-08-10] FROM dbo.[2016-11-10]

Query Output - Provider ID: specifies Southeast Alabama Medical Center - Measure ID:  refers to prophylactic antibiotic use - Measure Start Date/End Date: time frame from which data was collected - Score: the # of patients with antibiotic overuse - Sample: all surgical patients with no evidence of prior infection

Step 4: Transfer query results to Excel Highlight the entire output, right click & select “Copy with Headers” Open Excel & paste into a new spreadsheet

Step 5: Calculate rates & control limits To calculate: Midway Point: ( [Measure Start Date] + [Measure End Data] ) / 2 *Remember to convert this result into a date format Rate of Overuse: [Score] / [Sample] Grand Rate: SUM (Score) / SUM (Sample) Upper Limit: Grand Rate + 1.96*SQRT((Grand Rate*(1-Grand Rate))/Sample) Lower Limit: Grand Rate - 1.96*SQRT((Grand Rate*(1-Grand Rate))/Sample)

Step 6: Plot the control chart Limits spread wider due to a smaller sample size Analysis: There was a statistically significant increase in the rate of antibiotic overuse for both the 4/1/15 and the 5/17/15 time frames. All other time frames had rates that were within our control limits.

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