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Intervention program improved care practice implementation in Canadian ICUs
Curtis J. JAMA. 2011;doi:10.1001/jama.2011.8.
Scales
D. JAMA. 2011;doi:10.1001/jama.2010.2000.
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A multicenter quality-improvement program improved the adoption of care practices in a network of community ICUs in Canada, according to new data published online by the Journal of the American Medical Association.
“Community ICUs admit the majority of critically ill patients and have fewer resources for implementing quality improvement initiatives,” the researchers wrote. “Our videoconferencing network is one model for helping health care workers in geographically dispersed community hospitals to improve quality by accessing resources usually restricted to academic hospitals.”
The video conference-based intervention involved expert-led educational sessions, an audit and feedback, as well as the dissemination of algorithms to sequentially improve delivery of six practices. Admissions from 15 community hospital ICUs in Ontario, Canada, were analyzed, 9,269 during the trial period (November 2005-October 2006) and 7,141 during a decay monitoring period (December 2006-August 2007).
According to researchers, compared with controls, the adoption of care practices in the intervention ICUs was noticeably higher (OR=2.79; 95% CI, 1.00-7.74). Adherence to semi-recumbent positioning in the intervention ICUs significantly improved in the first month compared with the last month (49.8%-89.6% of eligible patient-days; OR=6.35; 95% CI, 1.85-21.79), whereas only nonsignificant improvements were reported in the control arm (80.1%-90.2% of eligible patient-days; OR=2.04; 95% CI, 0.82-5.07).
Further, the greatest improvements in delivery from first to last month in intervention ICUs occurred for semi-recumbent positioning to prevent ventilator-associated pneumonia (50% of patient-days in the first month vs. 90% in the last month) and precautions to prevent catheter-related bloodstream infection (10.6% vs. 70% of patients receiving central lines).
In an accompanying editorial, J. Randall Curtis, MD, MPH,of the University of Washington, Seattle, and Mitchell M. Levy, MD,with the Rhode Island Hospital, Providence, said the most interesting aspect of this study is that it was funded by an organization that funds delivery of health care, rather than by a research funding agency.
“To make significant steps toward improving the quality of health care and controlling the rate of increase in health care costs, this is an important model for the future,” they said. “The use of health care reimbursement to encourage and enforce quality is a reality of the US health care system today and in the future, but these quality measures must be selected and implemented based on rigorous science, and the implementation must be demonstrated to be effective without unintended consequences that lower quality in other ways or other areas of health care.”
Disclosures: Drs. Curtis and Levy reported no relevant financial disclosures.
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