Nov 11, 2016
Research by Qualidigm, in partnership with the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS), and other national leading institutions, determined that the incidence of ventilator-associated pneumonia (VAP) for patients treated in medical and surgical intensive care units has remained stable over a nine year period, reports a new research letter published in the Journal of the American Medical Association (JAMA). The research letter, “Trend in Ventilator-Associated Pneumonia Rates Between 2005 and 2013” funded by AHRQ, questions the VAP rates reported by the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), which highlighted a marked decline during a similar time period.
The researchers used medical record data of Medicare patients 65 years of age and older from the Medicare Patient Safety Monitoring System, the nation’s largest randomly selected medical record abstraction-based database designed for patient safety tracking. The analysis included VAP rates for patients hospitalized in the United States during 2005 through 2013 relating to these four conditions:
- Acute Myocardial Infarction (heart attack)
- Heart Failure
- Pneumonia (including a primary diagnosis of sepsis or respiratory failure and a secondary diagnosis of pneumonia)
- Surgical Care
The researchers studied patients within the study’s timeframe for evidence of VAP and found the incidence rates were stable over time, with an observed rate of 10.8% during 2005-2006, 9.7% during 2012-2013, and an adjusted average annual change of 0.00%. While the difference between the MPSMS findings and the decline in VAP rates reported by NHSN could be due to the differences in MPSMS and NHSN measure definitions, hospitals or patient groups, or changes in characteristics of hospital reporting over time, there is significant concern that rates reported by hospitals to NHSN are influenced by bias. The dichotomy between VAP rates reported to the NHSN and measured in MPSMS supports the concern that surveillance using traditional definitions may be unreliable. Furthermore, this report demonstrates that VAP remains an important clinical problem and demonstrates the need for further research on how to prevent and treat VAP.
“VAP is an important cause of morbidity and mortality and has been a target of extensive quality improvement efforts in the United States, yet VAP rates remain stubbornly high,” said Mark Metersky, M.D., lead author of the study and director of the Center for Bronchiectasis Care, Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine. “The severity of this health issue is demonstrated through World Pneumonia Day, which is held annually on November 12 to raise awareness of pneumonia, promote prevention and treatment, and generate global action to effectively treat this illness.” said Metersky.
The study’s authors are Mark Metersky, MD (University of Connecticut, also affiliated with Qualidigm); Yun Wang, PhD (Harvard School of Public Health, also affiliated with Qualidigm); Michael Klompas, MD (Harvard Medical School); Shelia Eckenrode, RN, Anila Bakullari, BS (Qualidigm); and Noel Eldridge (AHRQ).
“Trend in Ventilator-Associated Pneumonia Rates Between 2005 and 2013” is available via the JAMA website, www.jamanetwork.com.