Appendix N. Surgeon Focus Group Guide

Investigators from Denver Health, Intermountain Healthcare, and the Salt Lake City Veterans Affairs Medical Center have been funded by the Agency for Healthcare Research and Quality to study ways for Improving the Measurement of Surgical Site Infection Risk Stratification and Outcome Detection. The primary purpose of this focus group is to assess surgeon and surgical team acceptance of risk stratification models. In particular, our study aims to explore SSI risk for the following procedures: coronary artery bypass grafts with chest and donor site incisions, coronary artery bypass grafts with chest incision alone, herniorrhaphy, hip prosthesis/arthroplasty, and knee prosthesis/arthroplasty. Our focus group protocol has been submitted to and (exempted by) the Colorado Multiple Institutional Review Board; it is not felt that your voluntary participation presents any risk of psychological or physical harm. However, we do consider issues of confidentiality and privacy very seriously. For that reason, we will only use first names; should we want to include a quote in our report, we would contact you for permission prior to any individual attribution. We will be making an audiorecording, and taking notes during this session, because your comments are the data in this case, and we want to be sure to accurately capture this information.

I will be asking a series of questions; it is important that no one person dominate the conversation and that everyone has a chance to respond to these questions. It will be by job to manage the Q&A so please understand if we need to wrap up comments you are making to move along, allowing us to complete the focus group in the allotted one-hour time period. At the conclusion, we will give you a sheet to complete so that you can receive the small payment, which is a token of our appreciation. Do you have any questions before we begin?

1. There are several examples of common SSI risk assessment tools; for example, CDC National Nosocomial Infections risk index, homegrown rule-based surveillance systems, and the ACS NSQIP system. What do you think of common SSI risk assessment approaches that are currently being used?

   Probes:
   How do such tools impact the care that you deliver? Your group? Your organization?
   Has feedback/reporting from such a system led to improvements in care where you practice?

2. What variables do you consider be appropriately included in such systems?

   Probes:
   Are these general variables that apply to all surgeries?
   What about those specific to certain procedures or setting (i.e., ambulatory, inpatient)?

3. Are there new, additional variables that are not currently used in mainstream approaches that should be considered?

   Probes:
   Are these general variables that apply to all surgeries?
   What about those specific to certain procedures or setting (i.e., ambulatory, inpatient)?

4. What would you consider the importance and feasibility to access the data for the factors listed here (distribute risk factor list)? As you glance down the list, there are two columns—one for importance and one for feasibility—please place a check in the column next to each variable to indicate your rating.
5. To support safe, high quality care, what would be the preferred means by which to analyze risk data and provide feedback to surgical teams?

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