Hospital-Level Variation in the Use of Intensive Care
Hospital-Level Variation in the Use of Intensive Care
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DOI：
10.1111/j.1475-6773.2012.01402.x
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发表时间：
2012-10-01
影响因子：
3.4
通讯作者：
Cooke, Colin R.
中科院分区：
文献类型：
--
作者：
Seymour, Christopher W.;Iwashyna, Theodore J.;Cooke, Colin R.
目的确定医院在使用重症监护方面的不同程度，以及医院实践中独立于已知患者和医院因素的差异所造成的差异所占比例。数据来源2006年马里兰州和华盛顿州的州住院患者数据库中的医院出院数据。研究设计对90家具有重症监护能力的短期、急性护理医院进行横断面分析。数据收集/方法在对已知的患者和医院因素逐次调整后，我们使用混合效应Logistic回归模型得出的组内相关系数来量化医院在重症监护使用中的差异比例。主要研究结果不同医院的重症监护病房(ICU)住院患者的比例从3%到55%(中位数12%；IQR：9%，17%)。经患者因素调整后，医院间ICU使用总差异的19.7%(95%可信区间：15.1，24.4)可归因于医院。当加入观察到的医院特征时，由于未测量的医院因素而导致的重症监护使用总差异的比例下降了2614.6%(95%可信区间：11，18.3%)。结论不同医院间重症监护的使用存在很大的差异，与已知的患者或医院因素无关，可能是提高重症监护的效率和质量的目标。
Objective To determine the extent to which hospitals vary in the use of intensive care, and the proportion of variation attributable to differences in hospital practice that is independent of known patient and hospital factors. Data Source Hospital discharge data in the State Inpatient Database for Maryland and Washington States in 2006. Study Design Cross-sectional analysis of 90 short-term, acute care hospitals with critical care capabilities. Data Collection/Methods We quantified the proportion of variation in intensive care use attributable to hospitals using intraclass correlation coefficients derived from mixed-effects logistic regression models after successive adjustment for known patient and hospital factors. Principal Findings The proportion of hospitalized patients admitted to an intensive care unit (ICU) across hospitals ranged from 3 to 55 percent (median 12 percent; IQR: 9, 17 percent). After adjustment for patient factors, 19.7 percent (95 percent CI: 15.1, 24.4) of total variation in ICU use across hospitals was attributable to hospitals. When observed hospital characteristics were added, the proportion of total variation in intensive care use attributable to unmeasured hospital factors decreased by 2614.6 percent (95 percent CI: 11, 18.3 percent). Conclusions Wide variability exists in the use of intensive care across hospitals, not attributable to known patient or hospital factors, and may be a target to improve efficiency and quality of critical care.