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.
Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Health Care, and Brigham and Women's Hospital, Boston, Massachusetts 02215, USA.
Michael
M
Klompas
Richard
R
Platt
D019985:Benchmarking; D003951:Diagnostic Errors; D006761:Hospitals / Q000592:standards*; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D014481:United States