Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

He, Huaiwu; Ma, Xudong; Su, Longxiang; Wang, Lu; Guo, Yuhong; Shan, Guangliang; Hui, He; Zhou, Xiang; Liu, Dawei; Long, Yun; Zhao, Yupei; Zhang, Shuyang

doi:10.1186/s13054-020-2790-1

Cited by 17 publications

(22 citation statements)

References 33 publications

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“…Therefore, we designed this study to investigate the relationship between structure indicators of ICU and C ssc in China. In our previous study, a multifaceted Q ICU intervention was effective in improving 3 and 6-h C ssc in septic shock in China [ 14 ]. In this study, we found that 6-h C ssc was lower than 3-h C ssc .…”

Section: Discussionmentioning

confidence: 99%

Analysis of structure indicators influencing 3-h and 6-h compliance with the surviving sepsis campaign guidelines in China: a systematic review

Wang

Ma²,

et al. 2021

Eur J Med Res

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Background Compliance with the surviving sepsis campaign (SSC) guidelines (Cssc) is a key factor affecting the effects of sepsis treatment. We designed this study to investigate the relationships of the structure indicators of ICU on 3 and 6-h Cssc in China. Methods A total of 1854 hospitals were enrolled in a survey, led by the China National Critical Care Quality Control Center (China-NCCQC) from January 1, 2018, through December 31, 2018. We investigated the 1854 hospitals’ 3 and 6-h Cssc, including compliance with each specific measure of the 3-h and 6-h SSC bundles. We also investigated the actual level of the structure indicators of ICU, released by China-NCCQC in 2015.The outcomes were in adherence with the SSC guidelines (2016). Monitoring indicators included 3 and 6-h Cssc. Results In the subgroup, the rate of broad-spectrum antibiotic therapy was the highest, and the rate of CVP and ScvO2 measurement was the lowest among the items of 3 and 6-h Cssc. Structure indicators related to 3 and 6-h Cssc include the predicted mortality rate and the standardized mortality ratio (SMR). The relationships between 3 and 6-h Cssc and the proportion of ICU in total inpatient bed occupancy, the proportion of acute physiology and chronic health evaluation (APACHE) II score ≥ 15 in all ICU patients were uncertain. There was no relationship of 3 and 6-h Cssc with the proportion of ICU patients among total inpatients. Conclusions Structure indicators influencing 3 and 6-h Cssc in China are the predicted mortality rate and the standardized mortality rate.

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Section: Discussionmentioning

confidence: 99%

Analysis of structure indicators influencing 3-h and 6-h compliance with the surviving sepsis campaign guidelines in China: a systematic review

Wang

Ma²,

et al. 2021

Eur J Med Res

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“…We conducted a nationwide retrospective cohort study using the surveillance data from the national quality improvement (QI) program in ICUs in China. The program was designed and led by China National Critical Care Quality Control Center (China-NCCQC), the official national department regulating ICU quality control in China [ 13 ]. The national ICU QI program is a hospital-based continuous QI initiative, with multifaceted intervention implemented in multicenter voluntarily.…”

Section: Methodsmentioning

confidence: 99%

“…Fifteen ICU quality control indicators are adopted in the program, based on the recommendations by the National Health Commission of the People’s Republic of China on April 10, 2015 [ 17 ]. The indicators were described as previously [ 13 ], and listed as follows: (1) three structural indicators including proportion of ICU patients out of all total inpatients, proportion of ICU bed occupancy out of the total inpatient bed occupancy, proportion of ICU patients with acute physiology, and chronic health evaluation (APACHE) II scores ≥ 15 out of all ICU patients; (2) four process indicators including 3-h Surviving Sepsis Campaign (SSC) bundle compliance rate, 6-h SSC bundle compliance rate, microbiology specimen collection before antibiotic therapy, DVT prophylaxis rate); (3) eight outcome indicators including unplanned endotracheal extubation rate, reintubation rate within 48 h, rate of unplanned transfer to ICU, ICU readmission rate within 48 h, VAP incidence rate, CRBSI incidence rate, catheter-associated urinary tract infection incidence rate, ICU mortality.…”

Section: Methodsmentioning

confidence: 99%

Association of annual hospital septic shock case volume and hospital mortality

Chen

Ma²,

Kang

et al. 2022

Crit Care

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Background The burden of sepsis remains high in China. The relationship between case volume and hospital mortality among patients with septic shock, the most severe complication of sepsis, is unknown in China. Methods In this retrospective cohort study, we analyzed surveillance data from a national quality improvement program in intensive care units (ICUs) in China in 2020. Association between septic shock case volume and hospital mortality was analyzed using multivariate linear regression and restricted cubic splines. Results We enrolled a total of 134,046 septic shock cases in ICUs from 1902 hospitals in China during 2020. In this septic shock cohort, the median septic shock volume per hospital was 33 cases (interquartile range 14–76 cases), 41.4% were female, and more than half of the patients were over 61 years old, with average hospital mortality of 21.2%. An increase in case volume was associated with improved survival among septic shock cases. In the linear regression model, the highest quartile of septic shock volume was associated with lower hospital mortality compared with the lowest quartile (β − 0.86; 95% CI − 0.98, − 0.74; p < 0.001). Similar differences were found in hospitals of respective geographic locations and hospital levels. With case volume modeled as a continuous variable in a restricted cubic spline, a lower volume threshold of 40 cases before which a substantial reduction of the hospital mortality rate was observed. Conclusions The findings suggest that hospitals with higher septic shock case volume have lower hospital mortality in China. Further research is needed to explain the mechanism of this volume–outcome relationship.

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“…The QI factors of the ICU were evaluated according to the National Clinical Quality Control Indictors for Critical Care Medicine, which were o cially recommended for the assessment of ICU performance by the National Health Commission of the People's Republic of China in 2015 [14]. In this study, 10 related factors were analyzed, including 5 structural factors, 3 process factors and 2 outcome factors.…”

Section: Variable and Measurementsmentioning

confidence: 99%

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

Ding

Gao

et al. 2022

Preprint

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Purpose To investigate the effects of ICU quality control indicators on the VAP morbidity and mortality in China throughout 2019 Methods This was a retrospective study. A total of 1267 ICUs from 30 provinces in mainland China were included. Data were collected using the National Clinical Improvement System Data that reports ICU information. 10 related quality control indicators were analyzed, including 5 structural factors (patient-to-bed ratio, physician-to-bed ratio, nurse-to-bed ratio, patient-to-physician ratio, patient-to-nurse ratio), 3 process factors (unplanned endotracheal extubation rate, reintubation rate within 48h, and microbiology detection rate before antibiotic use) and 2 outcome factors (VAP morbidity and mortality). The information of most common infectious pathogens and most common used antibiotics in ICU was also collected. Generalized linear mixed models were used to analyze the association between these factors and VAP morbidity and mortality. Results The morbidity of VAP in these hospitals in 2019 was 5.03 (2.38, 10.25) per 1000 ventilator days, and the mortality of VAP was 11.11 (0.32, 26.00)%. The most common causative pathogen was Acinetobacter baumannii (in 39.98% hospitals), followed by Klebsiella pneumoniae (38.26%), Pseudomonas aeruginosa and Escherichia coli. In 26.90% hospitals, third-generation cephalosporin was the most used antibiotics, followed by carbapenem (24.22%), penicillin and beta-lactamase inhibitor combination (20.09%), cephalosporin with beta-lactamase inhibitor (17.93%). All the structural factors were significantly associated with VAP morbidity, but not with the mortality, although the trend was inconsistent. Process factors including unplanned endotracheal extubation rate, reintubation rate in 48 hours and microbiology detection rate before antibiotic use were associated with higher VAP mortality, while unplanned endotracheal extubation rate and reintubation rate in 48 hours were associated with higher VAP mortality. Furthermore, K. pneumoniae as the most common pathogen was associated with higher VAP mortality, and carbapenems as the most used antibiotics was associated with lower VAP mortality. Conclusion This study highlights the association between the ICU QC factors and VAP morbidity and mortality. The process factors rather than the structural factors need to be further improved for the QC of VAP in ICU.

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Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Cited by 17 publications

References 33 publications

Analysis of structure indicators influencing 3-h and 6-h compliance with the surviving sepsis campaign guidelines in China: a systematic review

Analysis of structure indicators influencing 3-h and 6-h compliance with the surviving sepsis campaign guidelines in China: a systematic review

Association of annual hospital septic shock case volume and hospital mortality

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

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