Ventilator-associated pneumonia--the wrong quality measure for benchmarking.
Legislators, payers, and quality-of-care advocates across the United States are considering requiring hospitals to report ventilator-associated pneumonia rates as a way to benchmark and reward quality of care. Accurate diagnosis of ventilator-associated pneumonia, however, is notoriously difficult because several common complications of critical care can mimic the clinical appearance of ventilator-associated pneumonia. The challenge is compounded by substantial subjectivity inherent in the current surveillance definition. These sources of variability make ventilator-associated pneumonia rates difficult to acquire, interpret, and compare both within and among institutions. Ventilator-associated pneumonia should be excluded from compulsory reporting initiatives until we develop and validate more objective outcome measures that meaningfully reflect quality of care for ventilated patients.
Klompas
Michael
M
Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Health Care, and Brigham and Women's Hospital, Boston, Massachusetts 02215, USA.
Platt
Richard
R
D019985:Benchmarking; D003951:Diagnostic Errors; D006761:Hospitals / Q000592:standards*; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D014481:United States