Variation in critical care services across North America and Western Europe
Variation in critical care services across North America and Western Europe
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DOI：
10.1097/ccm.0b013e318186aec8
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发表时间：
2008-10-01
影响因子：
8.8
通讯作者：
Rowan, Kathryn M.
中科院分区：
文献类型：
--
作者：
Wunsch, Hannah;Angus, Derek C.;Rowan, Kathryn M.
目的：重症监护在发达国家的医疗保健支出中占很大比例。然而，鲜为人知的是，关于重症监护服务的国际变化。我们试图通过比较八个国家的服务分布数据来了解重症监护服务的差异。设计：对现有的国家行政数据进行回顾性分析。我们确定了每个国家的数据来源，以提供有关急性护理医院和床位、重症监护病房和床位、重症监护入院以及重症监护床位定义的信息。所有数据均引用自2005年，尽可能接近2005年。设置：美国，法国，英国，加拿大，比利时，德国，荷兰和西班牙。患者：不可用。干预措施：无。测量和主要结果：没有标准定义存在急性护理医院或重症监护病房病床在各国。医院床位数从美国的221/100，000人到德国的593/100，000人变化了三倍。成人重症监护病房床位也是英国的7倍，从3.3/100，000人到德国的24.0/100，000人。重症监护病房每年的入院量变化为10倍，从英国的216/100，000人到德国的2353/100，000人。除美国外，所有国家的重症监护病房床位与医院床位的比率都高度相关（r = 0.90）。人均重症监护病房床位数与人均医疗保健支出之间的相关性最小（r = .45），但各国重症监护病房床位与重症监护病房患者的住院死亡率之间存在高度负相关性（r = -.82）。结论：各国之间的绝对重症监护服务差异很大，床位数量和入院人数都存在很大差异。人均重症监护病房床位数与总体卫生支出没有很强的相关性，但与死亡率有很强的相关性。这些研究结果表明，需要从所有国家的重症监护数据，因为它们是必不可少的研究解释，并就重症监护服务的政策决定。
Objective: Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in eight countries.Design: Retrospective review of existing national administrative data. We identified sources of data in each country to provide information on acute care hospitals and beds, intensive care units and beds, intensive care admissions, and definitions of intensive care beds. Data were all referenced and from as close to 2005 as possible.Setting: United States, France, United Kingdom, Canada, Belgium, Germany, The Netherlands, and Spain.Patients: Not available.Interventions: None.Measurements and Main Results: No standard definition existed for acute care hospital or intensive care unit beds across countries. Hospital beds varied three-fold from 221/100,000 population in the United States to 593/100,000 in Germany. Adult intensive care unit beds also ranged seven-fold from 3.3/100,000 population in the United Kingdom to 24.0/100,000 in Germany. Volume of intensive care unit admissions per year varied ten-fold from 216/100,000 population in the United Kingdom to 2353/ 100,000 in Germany. The ratio of intensive care unit beds to hospital beds was highly correlated across all countries except the United States (r = .90). There was minimal correlation between the number of intensive care unit beds per capita and health care spending per capita (r = .45), but high inverse correlation between intensive care unit beds and hospital mortality for intensive care unit patients across countries (r = -.82).Conclusions: Absolute critical care services vary dramatically between countries with wide differences in both numbers of beds and volume of admissions. The number of intensive care unit beds per capita is not strongly correlated with overall health expenditure, but does correlate strongly with mortality. These findings demonstrate the need for critical care data from all countries, as they are essential for interpretation of studies, and policy decisions regarding critical care services.