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Evaluating the Accuracy of Sampling Strategies for Estimation of Compliance Rate for Ventilator-Associated Pneumonia Process Measures

Published online by Cambridge University Press:  20 June 2016

Adam Diehl ,
Ting Yang ,
Kathleen Speck ,
James Battles ,
Sara E. Cosgrove ,
Sean Berenholtz  and
Michael Klompas
Adam Diehl
Affiliation:
Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
Ting Yang*
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Kathleen Speck
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
James Battles
Affiliation:
Agency for Healthcare Research and Quality (AHRQ), Rockville, Maryland
Sara E. Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sean Berenholtz
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.
*
Address correspondence to Ting Yang, PhD, MHS, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 E. Pratt St, 15th Fl, Baltimore, MD 21202 ([email protected]).
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Abstract

BACKGROUND

Measuring processes of care performance rates is an invaluable tool for quality improvement; however, collecting daily process measure data is time-consuming and burdensome.

OBJECTIVE

To evaluate the accuracy of sampling strategies to estimate monthly compliance rates with ventilator-associated pneumonia prevention measures.

SETTING AND PARTICIPANTS

A total of 37 intensive care units affiliated with 29 hospitals participating in a 2-state 35-month ventilator-associated pneumonia prevention collaborative. Analysis was limited to 325 unit-months with complete data entry rates.

METHODS

We calculated unit-month level actual and sample monthly compliance rates for 6 ventilator-associated pneumonia prevention measures, using 4 sampling strategies: sample 1 day per month, sample 1 day per week, sample 7 consecutive days per month, and sample 7 consecutive days per month plus additional consecutive days as necessary to obtain at least 30 ventilator-days for that month whenever possible. We compared sample versus actual rates using paired t test and χ2 test.

RESULTS

Mean sampling accuracy ranged 84%–97% for 1 day per month, 91%–98% for 1 day per week, 92%–98% for 7 consecutive days per month, and 96%–99% for 7 consecutive days with at least 30 days per month if possible. The most accurate sampling strategy was to sample 7 consecutive days with at least 30 ventilator-days per month if possible. With this strategy, sample rates were within 10% of actual rates in 88%–99% of unit-months and within 5% of actual rates in 74%–97% of unit-months.

CONCLUSION

Sampling process measures intermittently rather than continually can yield accurate estimates of process measure performance rates.

Infect Control Hosp Epidemiol 2016;37:1037–1043

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 9 , September 2016 , pp. 1037 - 1043
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

A.D. and T.Y. contributed equally to this article.

References

REFERENCES

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Diehl supplementary material

Appendix A

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