Send to

Choose Destination
See comment in PubMed Commons below
BMJ. 2011 Jan 28;342:d219. doi: 10.1136/bmj.d219.

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis.

Author information

  • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.



To evaluate whether implementation of the Michigan Keystone ICU project, a comprehensive statewide quality improvement initiative focused on reduction of infections, was associated with reductions in hospital mortality and length of stay for adults aged 65 or more admitted to intensive care units.


Retrospective comparative study, using data from Medicare claims.


Michigan and Midwest region, United States. Population The study period (October 2001 to December 2006) spanned two years before the project was initiated to 22 months after its implementation. The study sample included hospital admissions for patients treated in 95 study hospitals in Michigan (238,937 total admissions) compared with 364 hospitals in the surrounding Midwest region (1,091,547 total admissions).


Hospital mortality and length of hospital stay.


The overall trajectory of mortality outcomes differed significantly between the two groups upon implementation of the project (Wald test χ(2) = 8.73, P = 0.033). Reductions in mortality were significantly greater for the study group than for the comparison group 1-12 months (odds ratio 0.83, 95% confidence interval 0.79 to 0.87 v 0.88, 0.85 to 0.90, P = 0.041) and 13-22 months (0.76, 0.72 to 0.81 v 0.84, 0.81 to 0.86, P = 0.007) after implementation of the project. The overall trajectory of length of stay did not differ significantly between the groups upon implementation of the project (Wald test χ(2) = 2.05, P = 0.560). Group differences in adjusted length of stay compared with baseline did not reach significance during implementation of the project (-0.45 days, 95% confidence interval -0.62 to -0.28 v -0.35, -0.52 to -0.19) or during post-implementation months 1-12 (-0.59, -0.80 to -0.37 v -0.42, -0.59 to -0.25) and 13-22 (-0.67, -0.91 to -0.43 v -0.54, -0.72 to -0.37).


Implementation of the Keystone ICU project was associated with a significant decrease in hospital mortality in Michigan compared with the surrounding area. The project was not, however, sufficiently powered to show a significant difference in length of stay.

[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center