Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019

Abstract

Background Hospital and ICU structural factors are key factors affecting the quality of care as well as ICU patient outcomes. However, the data from China are scarce. This study was designed to investigate how differences in patient outcomes are associated with differences in hospital and ICU structure variables in China throughout 2019. Methods This was a multicenter observational study. Data from a total of 2820 hospitals were collected using the National Clinical Improvement System Data that reports ICU information in China. Data collection consisted of a) information on the hospital and ICU structural factors, including the hospital type, number of beds, staffing, among others, and b) ICU patient outcomes, including the mortality rate as well as the incidence of ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs). Generalized linear mixed models were used to analyse the association between hospital and ICU structural factors and patient outcomes. Results The median ICU patient mortality was 8.02% (3.78%, 14.35%), and the incidences of VAP, CRBSI, and CAUTI were 5.58 (1.55, 11.67) per 1000 ventilator days, 0.63 (0, 2.01) per 1000 catheter days, and 1.42 (0.37, 3.40) per 1000 catheter days, respectively. Mortality was significantly lower in public hospitals (β = − 0.018 (− 0.031, − 0.005), p = 0.006), hospitals with an ICU-to-hospital bed percentage of more than 2% (β = − 0.027 (− 0.034, -0.019), p < 0.001) and higher in hospitals with a bed-to-nurse ratio of more than 0.5:1 (β = 0.009 (0.001, 0.017), p = 0.027). The incidence of VAP was lower in public hospitals (β = − 0.036 (− 0.054, − 0.018), p < 0.001). The incidence of CRBSIs was lower in public hospitals (β = − 0.008 (− 0.014, − 0.002), p = 0.011) and higher in secondary hospitals (β = 0.005 (0.001, 0.009), p = 0.010), while the incidence of CAUTIs was higher in secondary hospitals (β = 0.010 (0.002, 0.018), p = 0.015). Conclusion This study highlights the association between specific ICU structural factors and patient outcomes. Modifying structural factors is a potential opportunity that could improve patient outcomes in ICUs.

Effect of ICU quality control indicators on VAP incidence and mortality: a Retrospective Study of 1267 hospitals in China

“…Traditionally, Adequate human resource allocation is one of the core element needed to ensure the quality of medical care[18], as ICU patients are highly dependent on nursing care, a shortage of nursing staff could be associated with insu cient supervision and recognition of state changes of the patients. Saker et al's study found that a high nurse-to-patient ratio was independently associated with a reduced risk of in hospital mortality [19], and Li et al found the similar result [13]. In our study, high nurse-to-bed ratio was also associated with lower VAP morbidity, but other factors such as patient-to-nurse ratio, physician-to-bed ratio showed the different trend.…”

“…shown effective reducing VAP rates in multidisciplinary ICUs [12].An analysis of the National Clinical Improvement System Data in China highlighted the association between speci c ICU structural factors and patients' outcomes [13]. Therefore, the aim of this study was to investigate the ICU QI factors and the mortality and morbidity of VAP and identify the association between these variables and patient outcomes.…”

Risk factors associated with hemodialysis catheter infection in a referral center

“…En cuanto al tiempo de inicio de la hemodiálisis no existe diferencia entre ambos grupos debido a que en ambos grupos la distribución del tiempo de inicio de la hemodiálisis fue similar, a diferencia de (29,48) otros estudios donde demostraron asociación entre infección y hemodiálisis menor a 1 año , mientras que en otros estudios la infección fue mayor en el grupo con mayor tiempo de En relación a la ubicación del catéter de hemodiálisis, los sujetos con catéter femoral tuvieron mayor riesgo de infección en comparación con la ubicación yugular. Este hallazgo es similar a otros (14,51) estudios que comparan la ubicación el catéter y el riesgo de bacteriemia .…”

Correction to: Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019

“…Following publication of the original article [ 1 ], the authors identified an error in the corresponding authors. The author Zhen Li is first author not a corresponding author.…”