Variation in severity-adjusted resource use and outcome in intensive care units

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http://hdl.handle.net/10138/340536

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Takala , J , Moser , A , Raj , R , Pettilä , V , Irincheeva , I , Selander , T , Kiiski , O , Varpula , T , Reinikainen , M & Jakob , S M 2022 , ' Variation in severity-adjusted resource use and outcome in intensive care units ' , Intensive Care Medicine , vol. 48 , no. 1 , pp. 67-77 . https://doi.org/10.1007/s00134-021-06546-4

Title: Variation in severity-adjusted resource use and outcome in intensive care units
Author: Takala, Jukka; Moser, Andre; Raj, Rahul; Pettilä, Ville; Irincheeva, Irina; Selander, Tuomas; Kiiski, Olli; Varpula, Tero; Reinikainen, Matti; Jakob, Stephan M.
Contributor organization: Clinicum
Neurokirurgian yksikkö
HUS Neurocenter
HUS Perioperative, Intensive Care and Pain Medicine
Department of Diagnostics and Therapeutics
Date: 2022-01
Language: eng
Number of pages: 11
Belongs to series: Intensive Care Medicine
ISSN: 0342-4642
DOI: https://doi.org/10.1007/s00134-021-06546-4
URI: http://hdl.handle.net/10138/340536
Abstract: Purpose Intensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure. Methods Data of 207,131 patients treated in 2008-2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015-2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015-2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models. Results SMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5-5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR. Conclusion The wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.
Subject: Intensive care unit
Hospital mortality
Health resources
Resource allocation
Health care benchmarking
Cost control
HOSPITAL MORTALITY
RISK PREDICTION
MODEL
PERFORMANCE
PATIENT
SYSTEM
SAPS-3
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by_nc
Usage restriction: openAccess
Self-archived version: publishedVersion


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