Causes and Effects of Hospital-Level Changes in ICU Bed Supply

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In the last thirty years the United States witnessed a transformation of the critical care delivery system marked by a simultaneous decrease in the number of hospitals providing critical care and an increase in the total number of intensive care unit beds. As a consequence, the US is not only providing more intensive care, but also concentrating this care in ever fewer numbers of hospitals. In an ongoing career-development award (K08) funded by the NHLBI, the applicant is studying the clinical impact of these changes on patient outcomes at the regional level. However, in the course of this work it has become increasingly clear that information is needed on not only the population-based implications of these changes, but also their underlying causes and effects at the individual hospital level. The overall goal of this project is to determine the causes and effects of hospital-level changes in the number of ICU beds from the perspectives of key decision makers. To accomplish this goal we will conduct and analyze semi-structured interviews with administrators from hospitals with increasing, unchanged and decreasing intensive care bed supply. Our study has two specific aims: 1) to determine the causes of hospital-level changes in the number of ICU beds, and 2) to evaluate the perceived effects of changes in the number of ICU beds. We will conduct semi-structured interviews with administrators in hospitals with varying ICU bed supply changes. We will then use thematic content analysis of the interview transcripts to develop a conceptual model for the causes underlying ICU bed supply changes. We will further analyze the interview transcripts to expand our conceptual model to include the effects of changes in ICU bed supply from the perspectives of key decision makers. Successful completion of these aims will produce rich insight into how changes in ICU infrastructure affect operations, financial metrics and clinical outcomes and will provide new hypotheses for organizational strategies to improve the care of patients with critical illness. These data will in turn inform a future R01 submission studying the impact of changes in bed supply at the hospital and region level on clinical outcomes for critically ill patients, contributing to the NHLBI's strategic vision to understand factors that account for differences in heath among populations. Additionally, the proposed research project will provide a unique opportunity for the applicant to receive additional mentored research training in qualitative research methods and organizational theory. Rigorous qualitative research is an increasingly important component of modern health care delivery science but is not part of the applicant's current K08, making this proposal synergistic with the applicant's K08 both scientifically and from a career development standpoint. Finally, the additional training, mentoring and experience are in-step with NHLBI's strategic vision to develop a scientific workforce capable of responding to current and future health challenges