Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
BMJ. 2011 Jan 28;342:d219. doi: 10.1136/bmj.d219.
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.
Retrospective comparative study, using data from Medicare claims.
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).
Hospital mortality and length of hospital stay.
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).
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.
评估密歇根基石 ICU 项目的实施情况，该项目是一项全面的全州范围的质量改进计划，重点是减少感染，是否与 65 岁及以上入住重症监护病房的成年人的医院死亡率和住院时间的减少有关。
回顾性比较研究，使用医疗保险索赔数据。
密歇根州和中西部地区，美国。研究期间（2001 年 10 月至 2006 年 12 月）跨越项目启动前两年和实施后 22 个月。研究样本包括在密歇根州 95 家研究医院（总计 238937 例住院）接受治疗的患者的住院治疗，以及在周边中西部地区 364 家医院（总计 1091547 例住院）接受治疗的患者。
医院死亡率和住院时间。
在项目实施后，两组患者的死亡率总体轨迹明显不同（Wald 检验χ(2) = 8.73，P = 0.033）。与对照组（1-12 个月：比值比 0.83，95%置信区间 0.79 至 0.87；13-22 个月：0.88，0.85 至 0.90）相比，研究组的死亡率下降幅度显著更大（1-12 个月：比值比 0.83，95%置信区间 0.79 至 0.87；13-22 个月：0.76，0.72 至 0.81），P = 0.041）和 13-22 个月（0.76，0.72 至 0.81 v 0.84，0.81 至 0.86，P = 0.007）。在项目实施后，两组患者的住院时间总体轨迹没有明显差异（Wald 检验χ(2) = 2.05，P = 0.560）。与基线相比，在项目实施期间（-0.45 天，95%置信区间-0.62 至-0.28 v -0.35，-0.52 至-0.19）和实施后 1-12 个月（-0.59，-0.80 至-0.37 v -0.42，-0.59 至-0.25）和 13-22 个月（-0.67，-0.91 至-0.43 v -0.54，-0.72 至-0.37），调整后的住院时间与对照组相比差异均无统计学意义。
与周边地区相比，密歇根州基石 ICU 项目的实施与医院死亡率的显著降低有关。然而，该项目没有足够的能力显示住院时间的差异有统计学意义。
