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Home / News & IndustryManaged Care Insight and Analysis
Updated: January 11, 2011
ICU Infections, Mortality Don’t Always Tell Hospital Quality, Study Reports

ICU-acquired infection rates are not an indication of patients’ mortality risk, according to researchers at the University of Pennsylvania, undermining a central tenet of many P4P initiatives.

To examine whether or not publicly-reported infection rates actually identify the best hospitals based on mortality, Dr. Kate Courtright, resident physician at the University of Pennsylvania, and colleagues looked at patients in 158 Pennsylvania hospitals especially at risk for two types of infections: pneumonia and blood stream infections.

They calculated hospital death rates, accounting for differences in illness severity, across 158 hospitals and compared them to ICU-acquired infection rates obtained from a public state website. They then used statistical strategies to determine the relationship between infections and death.

"We found that ICU-acquired infection rates as reported on a state web site did not correlate with death rates for at-risk patients," said Courtright, lead author of the abstract. "In fact, hospitals with lower rates of ICU-acquired infection did not also have lower death rates for at-risk patients."

Courtright said that ICU-acquired infections rates are likely to continue to be a part of hospital report cards, despite the limitations of those report cards.

She cautioned that policy-makers and the public should realize that these rates "provide limited information about the quality of the hospital, and may misidentify high and low performers."

More care is needed to make sure that hospital report cards don’t do more harm than good. This is especially important because under upcoming health care reform, infection rates are also to be used for hospital reimbursement – hospitals with high infection rates will not be reimbursed as well for their care. Such a strategy may actually penalize good hospitals with low mortality rates."

"Report cards only work if they successfully identify the best hospitals," concluded Courtright. "We were surprised to find that many hospitals with good report cards from an infection standpoint are not that good from a more important standpoint – patient survival. Additionally, many hospitals with high infection rates actually had very good survival rates."

Address: University of Pennsylvania, 3451 Walnut Street, Philadelphia, PA 19104; (215) 898-5000,

  This article was taken from:
Pay-For-Performance Reporter

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