Evaluating the impact of an oral care initiative on the risk of non-ventilator-associated hospital-acquired pneumonia using electronic clinical data and diagnostic coding surveillance criteria

Objective: We assessed the impact of an oral care initiative on non-ventilator-associated hospital-acquired pneumonia (NV-HAP) risk using two different measurement strategies. Methods: We evaluated changes in NV-HAP events among all patients admitted to 17 VA Medical Centers (1) across the period 10/01/2015–12/31/2019, and (2) one-year pre- vs post- each hospital’s oral care initiative start date. We modeled and compared observed versus predicted NV-HAP events per hospitalization using (1) an electronic clinical definition and (2) diagnosis codes, adjusting for patients’ demographics, vital signs, and laboratory results at presentation. Results: Among 333,257 hospitalizations, 1,922 (0.58%) met NV-HAP electronic clinical criteria and 2,386 (0.72%) diagnostic coding criteria. The risk of NV-HAP defined by electronic clinical criteria was 0.62% in October 2015 and 0.54% in December 2019 (estimated difference –0.084% [95% CI: –0.17%, 0.0056%]; the risk of NV-HAP defined by diagnostic coding decreased from 1.0% to 0.48% (estimated difference –0.53% [–0.63%, –0.43%]). In the one-year pre- vs post-analysis, there was no evidence of effect of the implementation on NV-HAP using either electronic clinical criteria (adjusted risk difference –0.078% (95% CI: –0.25%, 0.091%) or diagnostic coding criteria (adjusted risk difference –0.021% (95% CI: –0.18%, 0.14%). Conclusions: In a large multi-center study of hospitalized patients, we were unable to identify a clear effect of an oral care initiative on NV-HAP using electronic clinical criteria or diagnostic coding criteria.