Physician-attributable differences in intensive care unit costs - A single-center study
Physician-attributable differences in intensive care unit costs - A single-center study
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DOI：
10.1164/rccm.200511-1810oc
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发表时间：
2006-12-01
影响因子：
24.7
通讯作者：
Connors, Alfred F., Jr.
中科院分区：
文献类型：
--
作者：
Garland, Allan;Shaman, Ziad;Connors, Alfred F., Jr.
基本原理：在实践和结果的变化，不解释病人或疾病的特点，是常见的卫生保健，包括在重症监护病房（ICU）。目的：量化ICU内，医生之间的资源使用的变化在一个单一的医疗ICU.Methods：这是一个前瞻性的，非干预性的研究，在一个医疗ICU，9个重症监护医生提供护理在14天的轮换。对比性样本包括1,184名最初入院的患者，他们的护理由一名重症监护医生提供。构建了平均每日可支配费用、ICU住院时间和住院死亡率的多变量模型，调整了患者和疾病特征以及workload. Measures和主要结果：重症监护医师的身份是平均每日可支配费用的重要预测因素（p < 0.0001），但不是ICU住院时间（p = 0.33）或住院死亡率（p = 0.83）。除了急性疾病的严重程度和类型外，重症监护医生对费用的影响比其他所有变量都大。平均每日可自由支配的费用变化43%，在不同的intensivists，相当于一个平均差异为1,003美元，每次入院之间的最高和最低terciles的intensivists.Conclusions：有很大的差异，他们使用的资源量，以管理危重病人之间的重症监护。较高的资源使用与较低的住院时间或死亡率无关。
Rationale: Variation in practice and outcomes, not explained by patient or illness characteristics, is common in health care, including in intensive care units (ICUs).Objective: To quantify within-ICU, between-physician variation in resource use in a single medical ICU.Methods: This was a prospective, noninterventional study in a medical ICU where nine intensivists provide care in 14-d rotations. Consecutive sample consisted of 1,184 initial patient admissions whose care was provided by a single intensivist. Multivariate models were constructed for average daily discretionary costs, ICU length of stay, and hospital mortality, adjusting for patient and illness characteristics, and workload.Measurements and Main Results: The identity of the intensivist was a significant predictor for average daily discretionary costs (p < 0.0001), but not ICU length of stay (p = 0.33) or hospital mortality (p = 0.83). The intensivists had more influence on costs than all other variables except the severity and type of acute illness. Average daily discretionary costs varied by 43% across the different intensivists, equating to a mean difference of $1,003 per admission between the highest and lowest terciles of intensivists.Conclusions: There are large differences among intensivists in the amount of resources they use to manage critically ill patients. Higher resource use was not associated with lower length of stay or mortality.