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Variation in Risk-Adjusted Ventilator-Associated Pneumonia Days Within a Quality Collaborative.

Naveen F Sangji1, Jacob M Dougherty2, Hannan A Maqsood2

  • 1Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.

The Journal of Surgical Research
|June 13, 2024
PubMed
Summary
This summary is machine-generated.

Ventilator-associated pneumonia (VAP) rates vary significantly among trauma centers. Further investigation into outlier practices can help reduce VAP and improve patient outcomes.

Keywords:
MorbidityQuality improvementTrauma center performanceVentilator-associated pneumonia

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Area of Science:

  • Quality improvement in healthcare
  • Trauma surgery outcomes
  • Infection control in critical care

Background:

  • Ventilator-associated pneumonia (VAP) is a significant complication in critically ill patients, leading to increased mortality and healthcare costs.
  • Despite preventative measures, VAP rates remain high in trauma centers, necessitating quality assessment.
  • Hospital-acquired infections like VAP are critical quality metrics in intensive care settings.

Purpose of the Study:

  • To analyze and report the variation in risk-adjusted VAP rates across trauma centers within a statewide quality collaborative.
  • To identify high and low outlier institutions based on their VAP rates.
  • To provide a basis for further investigation into factors influencing VAP rates in trauma care.

Main Methods:

  • Utilized data from the Michigan Trauma Quality Improvement Program (MTQIP) for 35 trauma centers (November 2020 - January 2023).
  • Employed a patient-level Poisson model to calculate risk-adjusted VAP rates, controlling for injury severity, physiology, and comorbidities.
  • Performed observed-to-expected adjustments and identified outliers based on confidence intervals relative to the mean.

Main Results:

  • A total of 538 VAP cases were identified among 33,038 ventilator days, yielding an overall rate of 16.3 VAPs per 1000 ventilator days.
  • Significant variation in risk-adjusted VAP rates was observed, ranging from 0 to 33.0 VAPs per 1000 ventilator days.
  • Several trauma centers were identified as statistically significant high or low outliers.

Conclusions:

  • Substantial variation exists in VAP rates among trauma centers, indicating potential disparities in care or outcomes.
  • Investigating the practices and underlying factors contributing to the differences in VAP rates between outlier institutions is crucial.
  • Understanding these variations can inform strategies to reduce VAP incidence and improve patient outcomes in trauma care.