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American Journal of Medical Quality
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The Relationship Between Evidence-Based Practices and Survival in Patients Requiring Prolonged Mechanical Ventilation in Academic Medical Centers

Mark A. Keroack, MD, MPH

University of Kansas Medical Center, Kansas City, Kansas; University Health System Consortium, 2001 Spring Road, Suite 700, Oak Brook, IL 60523 keroack{at}uhc.edu

Julie Cerese, RN, MS

Joanne Cuny, RN, BSN

Richard Bankowitz, MD, MBA

Helen J. Neikirk, MA

Susan K. Pingleton, MD

University Health System Consortium, Oak Brook, Illinois, and the University of Kansas Medical Center, Kansas City, Kansas.

Studies suggest variable adoption of evidencebased practice guidelines. The authors hypothesized that compliance with guidelines for patients requiring mechanical ventilation would vary among academic medical centers and that this variation might be associated with survival. A total of 1463 intensive care unit cases receiving continuousmechanical ventilation for >96 hourswere reviewed. The variation in mortality based on compliance with 6 evidence-based practiceswas determined, and the effect of each intervention was estimated using a logistic regression model. Compliance varied widely across the participating centers. Astrong associationwith survival was seen for 2 of the 6practices: sedationmanagementand glycemic control (odds ratios fordeath of 0.30and0.46, respectively, eachP< .01). Spontaneous breathing trials, deep venous thrombosis prophylaxis, semirecumbent positioning, and stress ulcer prophylaxis were not associated with survival in the model. More consistent adoption of these practices represents an opportunity for academicmedical centers and was associated with enhanced survival.

Key Words: intensive care units • respiration • artificial • evidence-based medicine • practice guidelines

American Journal of Medical Quality, Vol. 21, No. 2, 91-100 (2006)
DOI: 10.1177/1062860605285732
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