ICU-acquired infection rates are not an indication of patients’ mortality risk, according to researchers the University of Pennsylvania, undermining a central tenet of many pay-for-performance initiatives.
Public reporting of quality data is increasingly common in healthcare. These “report cards” are designed to improve the quality of care by helping patients choose the best hospitals. Yet, they only work if they successfully identify high performers, and may be misleading if they steer patients toward poor performers.
The findings will be reported at the American Thoracic Society 2010 International Conference in New Orleans.
To examine whether or not publicly-reported infection rates actually identify the best hospitals, Kate Courtright, MD, resident physician at the University of Pennsylvania and colleagues looked at patients in Pennsylvania hospitals especially at risk for two types of infections: pneumonia and bloodstream infections. They calculated hospital death rates accounting for differences in illness severity across 158 hospitals, which included nearly 19,000 admissions involving mechanical ventilation and over 16,000 ICU admissions involving central venous catheterization, and compared them to ICU-acquired infection rates obtained from a public state website. They then used rank correlation and linear regression to determine the relationship between infections and death.
