OBJECTIVES : To conduct a systematic literature and internet review of healthcare quality in the context of hospital-acquired pneumonia. Here, we report results related to the validity of ventilator-associated pneumonia (VAP) quality metrics and effectiveness of the Center for Medicare and Medicaid Services (CMS) Hospital Acquired Conditions Reduction Program (HACRP).

METHODS : A literature review of healthcare quality in the context of hospital-acquired pneumonia was conducted in a systematic manner. Five domains related to healthcare quality were emphasized during the review: Developing guidelines and improvements for care, using data to monitor outcomes, reimbursement penalties for quality (no examples of reimbursement rewards were found) certification of providers and health plans, and developing and endorsing quality measures These terms were also cross-referenced these terms with the top 10 US News and World Report hospitals

RESULTS : Our search yielded 489 results, 40 of which were relevant to our review. Of these, 7 were pertinent to VAP quality metrics and effectiveness of the HACRP. A retrospective study found that the incidence of two hospital-acquired infections was modestly reduced following implementation of the CMS program. Conversely, a similar investigation comparing infection rates before and after HACRP implementation revealed that no significant differences were observed consequent to the program

CONCLUSIONS : Recent literature suggests that the CMS HACRP may not be serving its intended purpose. However, more evidence is needed to evaluate the outcomes of this program as hospitals continually undergo quality improvement. Current methods of detecting VAP are not reliable or feasible, making it unlikely that this condition will be added to the HACRP in the near/foreseeable future.