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Ventilator-Associated Pneumonia—The Wrong Quality Measure for Benchmarking
- Michael Klompas, MD, MPH; and
- Richard Platt, MD, MSc
- From Harvard Medical School, Harvard Pilgrim Health Care, and Brigham and Women's Hospital, Boston, Massachusetts.
Abstract
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.
Article and Author Information
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Acknowledgment: The authors thank Julia Przedworski for her invaluable assistance in researching state regulatory requirements for reporting ventilator-associated pneumonia.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Michael Klompas, MD, MPH, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.
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Current Author Addresses: Drs. Klompas and Platt: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.
