Intensive care services in the veterans health administration
Intensive care services in the veterans health administration
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DOI：
10.1378/chest.06-3083
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发表时间：
2007-11-01
期刊：
影响因子：
9.6
通讯作者：
Perlin, Jonathan
中科院分区：
文献类型：
--
作者：
Alimenoff, Peter;Sales, Anne;Perlin, Jonathan
目的：我们描述的国家组织和分布的重症监护服务内的退伍军人健康管理局（VHA），最大的单一的综合卫生保健系统在美国。数据来源：数据主要来自2004年的调查重症监护病房在VHA，电子分布的调查所有ICU在VHA。来自VHA所有213个ICU的医疗主任和护士经理对调查做出了回应。此外，我们提取的ICU入院和独特的退伍军人从国家VHA databases.Results服务的数量的数据：VHA有一个地理上分散的，多层次的护理系统与地理上的差异访问合格的退伍军人（变化从3.1到3.5 ICU病床每1,000例患者出院）和服务提供的变化（从10到19个1级ICU在四个地区）。一级ICU是最高级别的三级ICU，提供全方位的专科护理。与VHA开发的ICU护理水平相关的床位比例范围从东北部的55% I级床位到南部的73%，而4级床位占南部所有ICU床位的4%和中西部的10%。总体而言，VHA系统具有相当大的区域差异，但1级ICU在所有地理区域均可用，还有各个层次的区域集群。采用一个四级系统来对ICU进行评级，可能有助于监测和评估最小、最农村的设施所提供的护理质量。
Objective: We describe the national organization and distribution of intensive care services within the Veterans Health Administration (VHA), the largest single integrated health-care system in the United States.Data Sources: Data come primarily from the 2004 Survey of Intensive Care Units in VHA, an electronically distributed survey of all ICUs in the VHA. Medical directors and nurse managers from all 213 ICUs in the VHA responded to the survey. In addition, we extracted data on the number of ICU admissions and unique veterans served from national VHA databases.Results: The VHA has a geographically dispersed, multilevel system of care with variation in geographic access for eligible veterans (varying from 3.1 to 3.5 ICU beds per 1,000 patient discharges) and variation in service provision (from 10 to 19 level 1 ICUs across four regions). Level I ICUs are the highest tertiary-level ICUs, with the full range of subspecialty care. The proportion of beds associated with VHA-developed ICU levels of care ranges from 55% level I beds in the Northeast to 73% in the South, while level 4 beds represent 4% of all ICU beds in the South and 10% in the Midwest.Conclusions: Overall, the VHA system has a fair amount of regional variation, but level 1 ICUs are available in all geographic regions, and there are regional clusters of all levels. Adopting a four-level system for rating ICUs may assist in monitoring and assessing the quality of care provided in the smallest, most rural facilities.