# Understanding and Addressing Variation in Healthcare-Associated Infections After Adult Cardiac Surgery

> **NIH AHRQ R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $483,566

## Abstract

Project Summary/Abstract
Nearly 250,000 patients annually undergo surgical coronary revascularization and/or valve repair or replacement
in the US. Despite improvements in operative care and technology, patients remain at substantial risk of
postoperative complications that adversely impact quality of life and survival. Healthcare-acquired infections
“HAIs” (e.g., pulmonary, bloodstream, deep-sternal wound) occur in ~10% of patients undergoing these
operations and significantly increase 90-day payments by $10-$13K. Patients at higher versus lower HAI tercile
hospitals have higher (18% versus 9%) risk of major morbidity and mortality, p < 0.001. Despite existing efforts
focused on in-hospital HAI prevention practices (e.g., appropriate timing and type of antibiotics, nursing intensive
care unit bundle adherence), substantial interhospital variability persists in HAI rates. Only 2% of hospital
variation in HAI rates is explained by traditional factors, highlighting the need to identify significant determinants.
Our team has mapped provider care delivery networks serving cardiac surgery patients that reflect coordination
of patient disease management and care optimization (e.g., communication and information exchange) to
accomplish collaborative tasks (e.g., patient selection, timing of surgery, intensive care unit recovery, post-
discharge care) across multiple provider specialties and settings. We have merged national administrative claims
with clinical registry data among patients undergoing durable left ventricular assist devices and found: (1)
networks serving racially segregated communities display greater care fragmentation (i.e., weaker connectivity
among care providers) than those serving more integrated communities; (2) increased care fragmentation of
these networks operating at the hospital level is significantly associated with an increase in the probability of 90-
day HAIs and (3) the relationship between care fragmentation (a measure of network performance) and post-
discharge payments is significantly mediated by postoperative HAIs. Understanding the barriers and facilitators
for enhancing care delivery networks across phases of care delivery (pre-admission, index admission, post-
discharge) for the most commonly performed cardiac surgical operations would serve as the foundation for
targeted improvement strategies to address interhospital HAI variability. Community-based partnerships, that
help patients access community and health system resources as well as address healthcare inequities, would
serve as a novel focus for developing evidence-based, action-oriented HAI prevention recommendations. The
objective of this proposal is to identify areas of intervention within care delivery networks that enhance HAI
outcomes. This large-scale mixed methods proposal addresses the following aims: (1) Evaluate provider care
delivery networks as significant determinants of postoperative infections after cardiac surgery; (2) Develop a
comprehensiv...

## Key facts

- **NIH application ID:** 10502422
- **Project number:** 1R01HS029026-01
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** DONALD S LIKOSKY
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $483,566
- **Award type:** 1
- **Project period:** 2022-09-02 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10502422

## Citation

> US National Institutes of Health, RePORTER application 10502422, Understanding and Addressing Variation in Healthcare-Associated Infections After Adult Cardiac Surgery (1R01HS029026-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10502422. Licensed CC0.

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