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