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Clinical Investigations in Critical CareCommunity-Wide Assessment of Intensive Care Outcomes Using a Physiologically Based Prognostic Measure: Implications for Critical Care Delivery From Cleveland Health Quality Choice
Section snippets
Hospitals
The study was conducted in 38 ICUs in 28 hospitals participating in CHQC.10 Nineteen of the study ICUs were mixed medical and surgical units, eight ICUs were medical, eight ICUs were surgical, and three were neurologic and/or neurosurgical. Thirteen additional ICUs in study hospitals that specialized in coronary care (n = 11) or cardiovascular surgery (n = 2) were excluded from the study, as per CHQC protocols. Five hospitals were members of the Council of Teaching Hospitals of the Association
Results
The mean age of study patients was 63 years and 52% were men (Table 1). Forty-one percent of patients were admitted through the emergency department; 37% of patients (n = 42,416) were postoperative (ie, admitted to the ICU after undergoing a surgical procedure), and 63% of patients (n = 73,924) were nonoperative. The 10 most common ICU admission diagnoses accounted for nearly 50% of admissions and included the following: angina (n = 10,046); congestive heart failure (n = 8,007); trauma to the
Discussion
The current study represents one of the largest evaluations of variations in ICU mortality, and the first study (to our knowledge) to include all hospitals providing critical care services in a single metropolitan region. In analyses of > 116,000 patients admitted to ICUs in 28 hospitals over a 4-year period, several important findings emerge. First, an existing ICU risk stratification tool can be successfully implemented in a diverse spectrum of hospitals, as part of an ongoing collaboration
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2018, Brazilian Journal of AnesthesiologyBenchmarking, public reporting, and pay-for-performance: A mixed-methods survey of California pediatric intensive care unit medical directors
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Dr. Rosenthal was supported by a Career Development Award from the Health Services Research and Development Service, US Department of Veterans Affairs.
Financial disclosure: Drs. Sirio and Harper have provided consultingservices to APACHE Medical Systems, Inc (AMS). Dr. Harper is Executive Director of the Cleveland Health Quality Choice Program. AMS holds thecommercial copyright on the hospital mortality equations. APACHE and APACHE III are trademarks of AMS. While both the equations and the APACHE database are protected by commercial copyright, they areavailable to researchers for independent verification and furtheranalysis by contacting the authors or AMS.