Case-mix-adjusted length of stay and mortality in 23 Finnish ICUs
Case-mix-adjusted length of stay and mortality in 23 Finnish ICUs
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DOI：
10.1007/s00134-008-1377-0
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发表时间：
2009-06-01
影响因子：
38.9
通讯作者：
Pettila, Ville
中科院分区：
文献类型：
--
作者：
Niskanen, Minna;Reinikainen, Matti;Pettila, Ville
为了建立一个关于病例组合调整的住院时间(LOS)的工具，并研究ICU表现的临床和经济指标之间的关联。观察性队列研究。在芬兰的23个ICU。2000-2005年间，共有80,854名ICU住院患者，其中63,304人符合纳入标准。模型包括简化急性生理学评分(SAPS)II、年龄、急性生理学和慢性健康评估III的疾病类别、在ICU住院期间收集的单一最高治疗干预评分系统评分以及医院内有其他ICU。使用SAPS II、年龄和疾病类别作为协变量计算住院死亡概率。在验证样本中，所创建的模型解释了ICU LOS在不同入院患者中的28%和在ICU中的差异。预计ICU LOS为2.53±2.24天，观察到的ICU LOS为3.29±5.37天，P<；0.001。观察到的平均预期ICU损失与ICU标准化死亡率之间没有相关性(Spearman相关系数0.091，P=0.680)。我们开发了一个在全国范围内的ICU大型数据库中评估资源使用情况的工具。临床质量指标和经济质量指标之间似乎没有关联。
To create a tool for benchmarking intensive care units (ICUs) with respect to case-mix adjusted length of stay (LOS) and to study the association between clinical and economic measures of ICU performance.Observational cohort study.Twenty-three ICUs in Finland.A total of 80,854 consecutive ICU admissions during 2000-2005, of which 63,304 met the inclusion criteria.None.Linear regression was used to create a model that predicted ICU LOS. Simplified Acute Physiology Score (SAPS) II, age, disease categories according to Acute Physiology and Chronic Health Evaluation III, single highest Therapeutic Intervention Scoring System score collected during the ICU stay and presence of other ICUs in the hospital were included in the model. Probabilities of hospital death were calculated using SAPS II, age, and disease categories as covariates. In the validation sample, the created model accounted for 28% of variation in ICU LOS across individual admissions and 64% across ICUs. The expected ICU LOS was 2.53 +/- A 2.24 days and the observed ICU LOS was 3.29 +/- A 5.37 days, P < 0.001. There was no association between the mean observed - mean expected ICU LOS and standardized mortality ratios of the ICUs (Spearman correlation 0.091, P = 0.680).We developed a tool for the assessment of resource use in a large nationwide ICU database. It seems that there is no association between clinical and economic quality indicators.