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. 2011 Jan 28:342:d219.
doi: 10.1136/bmj.d219.

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis

Allison Lipitz-Snyderman  1 , Donald Steinwachs, Dale M Needham, Elizabeth Colantuoni, Laura L Morlock, Peter J Pronovost
Affiliations

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis

Allison Lipitz-Snyderman et al. BMJ. .

Abstract

Objective: To evaluate whether implementation of the Michigan Keystone ICU project, a comprehensive statewide quality improvement initiative focused on reduction of infections, was associated with reductions in hospital mortality and length of stay for adults aged 65 or more admitted to intensive care units.

Design: Retrospective comparative study, using data from Medicare claims.

Setting: Michigan and Midwest region, United States. Population The study period (October 2001 to December 2006) spanned two years before the project was initiated to 22 months after its implementation. The study sample included hospital admissions for patients treated in 95 study hospitals in Michigan (238,937 total admissions) compared with 364 hospitals in the surrounding Midwest region (1,091,547 total admissions).

Main outcome measures: Hospital mortality and length of hospital stay.

Results: The overall trajectory of mortality outcomes differed significantly between the two groups upon implementation of the project (Wald test χ(2) = 8.73, P = 0.033). Reductions in mortality were significantly greater for the study group than for the comparison group 1-12 months (odds ratio 0.83, 95% confidence interval 0.79 to 0.87 v 0.88, 0.85 to 0.90, P = 0.041) and 13-22 months (0.76, 0.72 to 0.81 v 0.84, 0.81 to 0.86, P = 0.007) after implementation of the project. The overall trajectory of length of stay did not differ significantly between the groups upon implementation of the project (Wald test χ(2) = 2.05, P = 0.560). Group differences in adjusted length of stay compared with baseline did not reach significance during implementation of the project (-0.45 days, 95% confidence interval -0.62 to -0.28 v -0.35, -0.52 to -0.19) or during post-implementation months 1-12 (-0.59, -0.80 to -0.37 v -0.42, -0.59 to -0.25) and 13-22 (-0.67, -0.91 to -0.43 v -0.54, -0.72 to -0.37).

Conclusions: Implementation of the Keystone ICU project was associated with a significant decrease in hospital mortality in Michigan compared with the surrounding area. The project was not, however, sufficiently powered to show a significant difference in length of stay.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that they had (1) No financial support for the submitted work. (2) PJP reports: receiving grants from the Agency for Healthcare Research and Quality, the National Patient Safety Agency, and private philanthropy to implement the Michigan programme in all 50 states and to measure and improve patient safety, receiving speaking honorariums and expenses for travel and accommodation from hospitals and healthcare systems, providing expert testimony to the US Congress, receiving royalties from sales of the book Safe Patients, Smart Hospitals, and receiving payment for development of education presentations from Leigh Bureau on quality and safety; (3) No spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work and (4) No non-financial interests that may be relevant to the submitted work.

Figures

None
Unadjusted and adjusted population level data on hospital mortality and average length of stay in Michigan hospitals and comparison hospitals
See this image and copyright information in PMC

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