| Introduction. It has been a decade since the IOM issued its report, to Err is Human, and during that time patient safety initiatives have dominated the literature. Leapfrog challenged hospitals to implement ICU inpatient physician staffing standards (IPS). IHI placed emphasis on reducing the incidence of ventilator-associated pneumonia (VAP). Both claim that by doing so thousands of lives and millions of dollars can be saved. VAP is the most common HAI in the ICU; approximately 10% of ventilated patients. Prevention strategies to reduce VAP rates are well established. This study examines whether meeting the Leapfrog IPS standard reduces the incidence of VAP. Two groups of California hospitals are compared to test the hypothesis that IPS standard are associated with lower VAP rates.;Methodology. 2007 de-identified patient data from California hospitals is extracted from the OSHPD data base. VAP rates are calculated for 161 California hospitals that responded to the Leapfrog survey. 60 hospitals clearly met IPS standards---101 clearly did not. The mean VAP rates are statistically compared through regression analysis, controlling for risk factors: ventilator duration, COPD, age, surgery, and trauma. A separate analysis is performed using the patient as the unit of measure using propensity scoring to control for selection bias, while controlling for the same risk factors.;Results. Hospitals meeting IPS standards have lower VAP rates. Regression of hospital VAP rates does not show statistical significance, p = .077. Propensity score regression shows a strong statistical difference, p = .003. The relative reduced risk of VAP in a hospital meeting IPS standards is 11%.;Conclusions. VAP rates are lower in California hospitals that meet IPS standards. There are policy, economic and clinical implications from the results. Ideas for future study are offered. |
