Keystone ICU project associated with lower hospital mortality in Michigan vs. region

The Michigan Keystone ICU project, a statewide quality improvement initiative, was associated with lower hospital mortality compared to surrounding Midwestern states, a study found.


The Michigan Keystone ICU project, a statewide quality improvement initiative, was associated with lower hospital mortality compared to surrounding Midwestern states, a study found.

Previous research has shown that the Michigan Keystone ICU project reduced catheter-related bloodstream infection rates and ventilator-associated pneumonia in the ICU through its promotion of evidence-based practices, improved communication and a culture of safety. This retrospective study used Medicare claims data to evaluate whether the initiative was associated with fewer deaths and lower length of stay for older adults in ICUs in Michigan compared to other Midwestern states. The study period spanned October 2001 to December 2006, representing a start date two years before the project was initiated to 22 months after its implementation. It included hospital admissions for patients age 65 years and older in 95 Michigan hospitals (238,937 total admissions) compared with 364 hospitals in the surrounding Midwest region (1,091,547 admissions).

The trajectory of mortality differed significantly between the study and comparison groups once the initiative was implemented (Wald test X2=8.73, P =0.033). Mortality reductions were greater for the study group than the comparison group at 1 to 12 months after project implementation (odds ratio [OR], 0.83, 95% CI, 0.79 to 0.87 vs. OR, 0.88, 95% CI, 0.85 to 0.90; P =0.041) and 13 to 22 months after implementation (OR, 0.76, 95% CI, 0.72 to 0.81 vs. OR, 0.84, 95% CI, 0.81 to 0.86; P =0.007). Length of stay did not differ significantly between the groups during or after implementation. Results were published online Jan. 31 by BMJ.

The study results may be conservative, since all Michigan hospitals were included in the study group although only 77% actually participated and contributed data to the Keystone ICU project, the authors noted. Improvement in mortality increased over the two post-implementation periods, suggesting the full benefit of the program took time to be realized, and/or that other quality initiatives at Michigan hospitals during this time may have boosted the effect, they wrote. Overall, the findings suggest that large-scale, robust and successful quality improvement initiatives can reduce adverse events, improve quality of care, and save lives, they concluded.

ACP Hospitalist ran an article in May 2010 about how the Michigan Keystone ICU project helped reduce catheter-associated urinary tract infections.