The impact of variation in the ICU bed supply on utilization of intensive care services

ICU床位供应变化对重症监护服务利用的影响

• 批准号: 9122536
• 负责人: Ian Barbash
• 金额: $ 7.91万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9122536
• 关键词: Address; Administrator; Admission activity; Affect; American; Beds; Calculi; Caring; Case Mixes; Certificate of Need; Clinical; Critical Care; Critical Illness; Data; Databases; Developed Countries; Disseminated Malignant Neoplasm; Economics; Elasticity; Goals; Growth; Guidelines; Health; Health Care Costs; Health Policy; Health Services; Health system; Healthcare; Hospital Administrators; Hospitals; Information Systems; Inpatients; Intensive Care; Intensive Care Units; Intervention; K-Series Research Career Programs; Knowledge; Laws; Lead; Measures; Mechanical ventilation; Medicare; Mentors; Modeling; Morbidity - disease rate; Myocardial Infarction; Natural experiment; Outcome; Patient Admission; Patient-Focused Outcomes; Patients; Pattern; Policies; Policy Analysis; Policy Maker; Principal Investigator; Reporting; Research Personnel; Research Training; Resources; Sampling; Services; Severities; Severity of illness; Statistical Data Interpretation; Statistical Models; System; Techniques; Terminal Disease; Testing; Time; Triage; United States; Variant; base; career; cohort; cost; design; experience; health care service utilization; improved; innovation; insight; mortality; pressure; prevent; public health relevance; skills

 DESCRIPTION (provided by applicant): Critical illness poses an enormous burden on the health system in terms of morbidity, mortality, and costs. In order to reduce this burden many experts have proposed limiting the supply of intensive care unit (ICU) beds, forcing clinicians to limit ICU utilization through implicit rationing of services. The potential value of ICU bed limitations hinges on the econometric notion of "demand elasticity", also known as "supply induced demand", which holds that the availability of ICU beds in part influences their utilization There is substantial indirect evidence in support of demand elasticity in the ICU: in comparison to other similarly developed nations, the United States has more ICU beds per capita and admits more patients to the ICU without achieving better outcomes; and hospitals vary widely in the proportion of patients admitted to the ICU without differences and outcome. However, at present direct evidence is limited to small, single-center studies examining how ICU admission patterns change with changing ICU bed numbers. Although policy levers to control the ICU bed supply exist, such as certificate of need laws, more robust evidence is needed before we can consider these options. To fill this critical knowledge gap, we will perform the first multicenter, nationally representative study of the effect of changes in the ICU bed supply on intensive care utilization. Our central hypothesis is that as the ICU bed supply increases ICU case mix also changes in specific ways-low severity patients that are too well to benefit and high severity patients that are too sick to benefit will be more likely to be admitted to the ICU. To test this hypothesis we will capitalize on a natural experiment by which some US hospitals add ICU beds over time, whereas others do not. Using nationally representative data from Healthcare Cost and Utilization Project's (HCUP) State Inpatient Database (SID), we will apply a difference-in-differences approach that compares hospitals with and without an increasing ICU bed supply, controlling for other factors. First, we will characterize the effect of a change in the ICU bed supply on the proportion of ICU patients with relatively low illness severity, who are likely to survive without ICU admission. Second, we will determine the effect of a change in the ICU bed supply on the utilization of intensive care services among patients admitted to the hospital with terminal illness, for whom admission to the ICU unlikely to alter their survival. Together, these aims will provide the robust evidence necessary to support clinicians, health administrators, and policy makers in their efforts to develop local, regional, and national strategies to optimize resource utilization and improve patient outcomes. In addition, through a multifaceted research training plan, this project will provide the applicant with essential skills in econometric techniques, statistical modeling, and health policy analysis. Ultimately, these skills will facilitte his transition to a mentored career development award and a career as an independent critical care health services investigator capable of studying how system-level interventions affect critical care utilization and outcomes.

 描述（由申请人提供）：危重病在发病率、死亡率和成本方面给卫生系统带来了巨大负担。为了减轻这一负担，许多专家建议限制重症监护病房（ICU）床位的供应，迫使临床医生通过隐性配给服务来限制ICU的使用。ICU床位限制的潜在价值取决于“需求弹性”的经济计量概念，也称为“供应诱导需求”，该概念认为ICU床位的可用性部分影响其利用率。有大量间接证据支持ICU的需求弹性：与其他类似的发达国家相比，美国人均ICU床位更多，ICU收治的患者更多，但效果并不好;不同的医院在ICU收治病人的比例上差异很大，没有差异和结果。然而，目前的直接证据仅限于小型的单中心研究，研究ICU入院模式如何随着ICU床位数量的变化而变化。尽管存在控制ICU床位供应的政策杠杆，例如需求证明法，但在我们考虑这些选择之前，还需要更有力的证据。为了填补这一关键的知识空白，我们将进行第一次多中心， ICU床位供应变化对重症监护利用影响的全国代表性研究。我们的中心假设是，随着ICU床位供应的增加，ICU病例组合也会以特定的方式发生变化--病情太好而无法受益的低严重度患者和病情太重而无法受益的高严重度患者更有可能进入ICU。为了验证这一假设，我们将利用一个自然实验，一些美国医院随着时间的推移增加ICU床位，而其他医院则没有。使用来自医疗保健成本和利用项目（HCUP）国家住院患者数据库（SID）的全国代表性数据，我们将采用差异中的差异方法，比较医院是否增加ICU床位供应，并控制其他因素。首先，我们将描述ICU床位供应的变化对病情严重程度相对较低的ICU患者比例的影响，这些患者可能在没有ICU入院的情况下生存。其次，我们将确定ICU床位供应的变化对因绝症入院的患者重症监护服务利用率的影响，对这些患者来说，入住ICU不太可能改变他们的生存率。总之，这些目标将提供必要的有力证据，以支持临床医生，卫生管理人员和政策制定者努力制定地方，区域和国家战略，以优化资源利用和改善患者的结果。此外，通过多方面的研究培训计划，该项目将为申请人提供计量经济学技术，统计建模和卫生政策分析方面的基本技能。最终，这些技能将有助于他过渡到一个指导的职业发展奖和职业生涯作为一个独立的重症监护健康服务调查员能够研究系统级干预措施如何影响重症监护的利用和结果。