Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019

作者：Zhen Li, Zhen Li, Xudong Ma, Sifa Gao, Qi Li, Hongbo Luo, Jianhua Sun, Wei Du, Longxiang Su, Lu Wang, Qing Zhang, Zunzhu Li, Zunzhu Li, Xiang Zhou, Dawei Liu, Xue Wang, Xiangdong Guan, Yan Kang, Bin Xiong, Bingyu Qin, Kejian Qian, Chunting Wang, Mingyan Zhao, Xiaochun Ma, Xiangyou Yu, Jiandong Lin, Aijun Pan, Haibo Qiu, Feng Shen, Shusheng Li, Yuhang Ai, Xiaohong Xie, Jing Yan, Weidong Wu, Meili Duan, Linjun Wan, Xiaojun Yang, Jian Liu, Lei Xu, Dongpo Jiang, Lei Xu, Chen Zhuang, Guoying Lin, Zhengping Yang, Zhenjie Hu · 发表于：Critical Care · 年份：2022 · DOI：10.1186/s13054-022-03892-7 · 被引用次数：26 · 研究领域：Nosocomial Infections in ICU、Sepsis Diagnosis and Treatment、Surgical site infection prevention

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...