Abstract
Aim
The primary objective of the IMPRESS study is to assess the causal effects of the IQM peer review on mortality in patients ventilated > 24 h. Secondary analyses are conducted for mortality in patients with myocardial infarction, stroke, COPD, pneumonia, and the procedural provision of a colorectal resection. This article provides a description of the study design and presents baseline results.
Subjects and methods
Descriptive statistics for 231 included hospitals and patient characteristics.
Results
Due to randomization, the treatment/control group hospitals were similar with respect to the mortality in patients ventilated > 24 h and other patient and hospital characteristics at baseline. Mortality was highest (lowest) in patients ventilated > 24 h (with colorectal resection).
Conclusion
The IMPRESS study provides a unique opportunity to assess the impact of the IQM peer review on the mortality in patients ventilated > 24 h. The secondary, exploratory, and qualitative analyses are expected to provide insights on determinants of in-hospital mortality, structure and process quality, and the robustness of different approaches to risk adjustment of quality indicators.
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References
BBSR (2014) Laufende Raumbeobachtung - Raumabgrenzungen. www.bbsr.bund.de/BBSR/DE/Raumbeobachtung/Raumabgrenzungen/StadtLandRegionen_Typen/StadtLandRegionen_Typen.html. Accessed 11 Mar 2019
Bundesärztekammer (2011) Curriculum “ärztliches peer review”
Dimick JB, Ryan AM (2014) Methods for evaluating changes in health care policy: the difference-in-differences approach. JAMA 312:2401–2402
Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27
Eran O, Novack V, Gilutz H, Zahger D (2011) Comparison of thrombolysis in myocardial infarction, global registry of acute coronary events, and acute physiology and chronic health evaluation II risk scores in patients with acute myocardial infarction who require mechanical ventilation for more than 24 hours. Am J Cardiol 107:343–346. https://doi.org/10.1016/j.amjcard.2010.09.024
Fernandez-Zamora MD et al (2018) Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respir Care 63:550–557. https://doi.org/10.4187/respcare.04915
Gillespie DJ, Marsh HMM, Divertie MB, Meadows JA (1986) Clinical outcome of respiratory-failure in patients requiring prolonged (greater-than 24 hours) mechanical ventilation. Chest 90:364–369. https://doi.org/10.1378/chest.90.3.364
Grol R (1994) Quality improvement by peer review in primary care: a practical guide. Qual Health Care 3:147–152
IQM (2019a) Qualitätsergebnisse. www.initiative-qualitaetsmedizin.de/qualitatsmethodik/qualitatsergebnisse/. Accessed 11 Mar 2019
IQM (2019b) Unsere neuen Mitglieder. www.initiative-qualitaetsmedizin.de/home/unsere-neuen-mitglieder/. Accessed 11 Mar 2019
Krahwinkel W et al (2016) The effect of peer review on mortality rates. Int J Qual Health Care 28:594–600. https://doi.org/10.1093/intqhc/mzw072
Krishnan JA, Moore D, Robeson C, Rand CS, Fessler HE (2004) A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation. Am J Respir Crit Care Med 169:673–678. https://doi.org/10.1164/rccm.200306-7610C
Mansky T, Nimptsch U, Cools A, Hellerhoff F (2016) G-IQI - German inpatient quality indicators version 5.0. Band 2. Definitionshandbuch für das Datenjahr 2016 www.seqmgw.tu-berlin.de/fileadmin/fg241/GIQI_V50_Band_1.pdf. Accessed 11 March 2019
Nimptsch U, Mansky T (2013) Quality measurement combined with peer review improved German in-hospital mortality rates for four diseases. Health Aff 32:1616–1623. https://doi.org/10.1377/hlthaff.2012.0925
Petzold T, Tesch F, Eberlein-Gonska M, Schmitt J (2017) Ermittlung geeigneter Kriterien als Entscheidungshilfe für die zielgerichtete Auslösung des IQM Peer Review Verfahrens. In: Eberlein-Gonska M, Martin J, Zacher J (eds) Handbuch IQM. Konsequent transparent - Qualität mit Routinedaten. Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin, pp 125–127
Pouw ME, Peelen LM, Lingsma HF, Pieter D, Steyerberg E, Kalkman CJ, Moons KG (2013) Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization. PLoS One 8:e59160
Rink O (2012) Das IQM Peer Review Verfahren–Ergebnisse der Initiative Qualitätsmedizin. Z für Evidenz, Fortbild und Qual im Gesundheitsw 106:560–565
Van Belle G, Fisher LD, Heagerty PJ, Lumley T (2004) Biostatistics: a methodology for the health sciences, 2nd edn. Wiley, Hoboken
Walther F, Schoffer O, Schmitt J (2018) Effectiveness of a collegial consultation procedure to improve in-patient care—a pragmatic cluster randomized controlled trial. ISRCTN. https://doi.org/10.1186/ISRCTN10188560 . Accessed 11 Mar 2019
Acknowledgements
The authors are grateful for the support of Dr. Claudia Winkelmair and the IQM office. We also thank the participating IQM hospitals and the peer reviewers.
Funding
The IMPRESS study is funded by the Innovation Fund of the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA), Germany. Funding number: 01VSF16013.
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Peter C. Scriba and Ralf Kuhlen are members of the scientific advisory board of the Initiative Qualitätsmedizin e.V. (IQM). Maria Eberlein-Gonska serves as an external expert for IQM. The other authors declare that they have no conflict of interest.
Ethics approval and consent to participate
The study was approved by the ethics committee of the TU Dresden. Written consent of participation was obtained from all included IQM member hospitals.
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Schmitt, J., Schoffer, O., Walther, F. et al. Effectiveness of the IQM peer review procedure to improve in-patient care—a pragmatic cluster randomized controlled trial (IMPRESS): study design and baseline results. J Public Health (Berl.) 29, 195–203 (2021). https://doi.org/10.1007/s10389-019-01118-9
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DOI: https://doi.org/10.1007/s10389-019-01118-9
Keywords
- Peer review
- Ventilation
- Hospital mortality
- Cluster-randomized controlled trial