Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019
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Published:2022-01-21
Issue:1
Volume:26
Page:
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ISSN:1364-8535
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Container-title:Critical Care
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language:en
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Short-container-title:Crit Care
Author:
Li ZhenORCID, Ma Xudong, Gao Sifa, Li Qi, Luo Hongbo, Sun Jianhua, Du Wei, Su Longxiang, Wang Lu, Zhang Qing, Li Zunzhu, Zhou Xiang, Liu Dawei, Wang Xue, Guan Xiangdong, Kang Yan, Xiong Bin, Qin Bingyu, Qian Kejian, Wang Chunting, Zhao Mingyan, Ma Xiaochun, Yu Xiangyou, Lin Jiandong, Pan Aijun, Qiu Haibo, Shen Feng, Li Shusheng, Ai Yuhang, Xie Xiaohong, Yan Jing, Wu Weidong, Duan Meili, Wan Linjun, Yang Xiaojun, Liu Jian, Xu Hang, Jiang Dongpo, Xu Lei, Chen Zhuang, Lin Guoying, Yang Zhengping, Hu Zhenjie,
Abstract
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.
Funder
National Key R&D Program of China CAMS Innovation Fund for Medical Sciences Beijing Municipal Natural Science Foundation CMB Open Competition Program
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
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