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首页> 外文学位 >A comparison of ventilator-associated pneumonia rates in California hospitals that either meet or fail to meet the Leapfrog ICU physician staffing standards.
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A comparison of ventilator-associated pneumonia rates in California hospitals that either meet or fail to meet the Leapfrog ICU physician staffing standards.

机译：达到或不达到Leapfrog ICU医生人员配备标准的加利福尼亚医院中与呼吸机相关的肺炎发生率的比较。

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摘要

Introduction. It has been a decade since the IOM issued its report, to Err is Human, and during that time patient safety initiatives have dominated the literature. Leapfrog challenged hospitals to implement ICU inpatient physician staffing standards (IPS). IHI placed emphasis on reducing the incidence of ventilator-associated pneumonia (VAP). Both claim that by doing so thousands of lives and millions of dollars can be saved. VAP is the most common HAI in the ICU; approximately 10% of ventilated patients. Prevention strategies to reduce VAP rates are well established. This study examines whether meeting the Leapfrog IPS standard reduces the incidence of VAP. Two groups of California hospitals are compared to test the hypothesis that IPS standard are associated with lower VAP rates.;Methodology. 2007 de-identified patient data from California hospitals is extracted from the OSHPD data base. VAP rates are calculated for 161 California hospitals that responded to the Leapfrog survey. 60 hospitals clearly met IPS standards---101 clearly did not. The mean VAP rates are statistically compared through regression analysis, controlling for risk factors: ventilator duration, COPD, age, surgery, and trauma. A separate analysis is performed using the patient as the unit of measure using propensity scoring to control for selection bias, while controlling for the same risk factors.;Results. Hospitals meeting IPS standards have lower VAP rates. Regression of hospital VAP rates does not show statistical significance, p = .077. Propensity score regression shows a strong statistical difference, p = .003. The relative reduced risk of VAP in a hospital meeting IPS standards is 11%.;Conclusions. VAP rates are lower in California hospitals that meet IPS standards. There are policy, economic and clinical implications from the results. Ideas for future study are offered.
机译：介绍。自从IOM向Err is Human发表报告以来已经有十年了，在这段时间里，患者安全措施主导了文献。 Leapfrog挑战医院实施ICU住院医师人员配置标准（IPS）。 IHI强调减少呼吸机相关性肺炎（VAP）的发生。双方都声称这样做可以挽救数千条生命和数百万美元。 VAP是ICU中最常见的HAI；约有10％的通气患者。降低VAP发生率的预防策略已经确立。这项研究检查了满足Leapfrog IPS标准是否可以降低VAP的发生率。比较了两组加利福尼亚医院，以检验IPS标准与较低的VAP率相关的假设。从OSHPD数据库中提取了2007年来自加利福尼亚医院的身份不明的患者数据。计算了对Leapfrog调查做出响应的161家加利福尼亚医院的VAP率。显然有60家医院符合IPS标准-101显然没有。通过回归分析对平均VAP率进行统计比较，控制风险因素：呼吸机持续时间，COPD，年龄，手术和外伤。使用患者评分作为控制单位，使用倾向评分法控制选择偏倚，同时控制相同的风险因素，进行单独的分析。符合IPS标准的医院的VAP率较低。医院VAP率的回归没有统计学意义，p = .077。倾向得分回归显示出很强的统计学差异，p = .003。在符合IPS标准的医院中，VAP相对降低的风险为11％。符合IPS标准的加利福尼亚医院的VAP率较低。结果有政策，经济和临床意义。提供了进一步研究的想法。

著录项

  • 作者

    Wilde, Gary K.;

  • 作者单位

    Medical University of South Carolina - College of Health Professions.;

  • 授予单位 Medical University of South Carolina - College of Health Professions.;
  • 学科 Health Sciences Epidemiology.;Health Sciences Health Care Management.
  • 学位 D.H.A.
  • 年度 2009
  • 页码 191 p.
  • 总页数 191
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;
  • 关键词

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