Ventilator-associated pneumonia--the wrong quality measure for benchmarking

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Health Services Research

Background:

• Legislators and payers are considering mandatory reporting of ventilator-associated pneumonia (VAP) rates to benchmark hospital quality.
• Accurate VAP diagnosis is difficult due to clinical mimicry by other critical care complications.
• Current VAP surveillance definitions are subjective, leading to variability.

Purpose of the Study:

• To evaluate the feasibility and reliability of current ventilator-associated pneumonia reporting for quality assessment.
• To highlight the challenges in accurately diagnosing VAP in critically ill patients.
• To advocate for improved outcome measures before implementing compulsory VAP reporting.

Main Methods:

• Review of diagnostic challenges in ventilator-associated pneumonia.
• Analysis of subjectivity in current VAP surveillance definitions.
• Discussion of implications for quality benchmarking and reporting.

Main Results:

• Substantial subjectivity exists in the current definition of ventilator-associated pneumonia.
• Common critical care complications can mimic VAP, complicating diagnosis.
• Variability in diagnosis makes VAP rates difficult to acquire, interpret, and compare.

Conclusions:

• Ventilator-associated pneumonia rates are currently unreliable for compulsory quality reporting.
• More objective outcome measures are needed to accurately reflect quality of care for ventilated patients.
• VAP should be excluded from mandatory reporting until validated objective measures are developed.