Internal Medicine, Beaumont Hospital Dearborn, Dearborn, Michigan, USA.
Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
BMJ Qual Saf. 2018 Apr;27(4):271-278. doi: 10.1136/bmjqs-2017-007342. Epub 2017 Nov 13.
Although important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing.
To test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use and patient outcomes.
Quasi-experimental, interrupted time series design at one study site with nine contemporaneous external controls.
Ten hospitals participating in a state-wide quality collaborative from 1 August 2014 to 31 July 2016.
963 hospitalised patients who received a PICC at the study site vs 6613 patients at nine control sites.
A multimodal intervention (tool, training, electronic changes, education) derived from MAGIC.
Appropriateness of PICC use and rates of PICC-associated complications. Segmented Poisson regression was used for analyses.
Absolute rates of inappropriate PICC use decreased substantially at the study site versus controls (91.3% to 65.3% (-26.0%) vs 72.2% to 69.6% (-2.6%); P<0.001). After adjusting for underlying trends and patient characteristics, however, a marginally significant 13.8% decrease in inappropriate PICC use occurred at the study site (incidence rate ratio 0.86 (95% CI 0.74 to 0.99; P=0.048)); no change was observed at control sites. While the incidence of all PICC complications decreased to a greater extent at the study site, the absolute difference between controls and intervention was small (33.9% to 26.7% (-7.2%) vs 22.4% to 20.8% (-1.6%); P=0.036).
Non-randomised design limits inference; the most effective component of the multimodal intervention is unknown; effects following implementation were modest.
In a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches.
尽管外周静脉置入中心静脉导管（PICC）的使用在临床护理中很重要，但有关其不适当使用的报告却越来越多。
测试密歇根静脉导管适宜性指南（MAGIC）的实施是否可以改善 PICC 的使用和患者的结局。
在一个研究地点进行的准实验性、中断时间序列设计，同时有九个同期外部对照。
2014 年 8 月 1 日至 2016 年 7 月 31 日期间，10 家参与全州质量合作的医院。
在研究地点接受 PICC 的 963 名住院患者与 9 个对照地点的 6613 名患者。
源自 MAGIC 的多模式干预（工具、培训、电子变更、教育）。
PICC 使用的适宜性和 PICC 相关并发症的发生率。使用分段泊松回归进行分析。
与对照组相比，研究地点的 PICC 不适当使用率显著降低（91.3%降至 65.3%（-26.0%），对照组为 72.2%降至 69.6%（-2.6%）；P<0.001）。然而，在调整了潜在趋势和患者特征后，研究地点的 PICC 不适当使用率仅略有显著降低 13.8%（发病率比 0.86（95%CI 0.74 至 0.99；P=0.048））；对照组没有变化。虽然所有 PICC 并发症的发生率都在更大程度上降低，但对照组和干预组之间的绝对差异较小（33.9%降至 26.7%（-7.2%），对照组为 22.4%降至 20.8%（-1.6%）；P=0.036）。
非随机设计限制了推断；多模式干预中最有效的部分尚不清楚；实施后的效果适度。
在多医院质量改进项目中，MAGIC 的实施在适度程度上改善了 PICC 的适宜性并减少了并发症。考虑到这项研究的规模和资源需求，未来的工作应该考虑类似方法的成本效益比。
