Impact of quality-of-care factors on pediatric intensive care unit mortality.
OBJECTIVE
To determine the importance of the following care factors previously associated with hospital quality on survival from pediatric intensive care: size of the intensive care unit (ICU), medical school teaching status of the hospital housing the ICU, specialist status (pediatric intensivist), and unit coordination.


METHODS
After a national survey, consecutive case series were collected at 16 sites randomly selected to represent unique combinations of quality-of-care factors.


METHODS
Pediatric ICUs.


METHODS
Consecutive admissions to each site.


METHODS
Patient mortality adjusted for physiologic status, diagnosis, and other mortality risk factors.


RESULTS
There were 5415 pediatric ICU admissions and 248 ICU deaths. The ICUs differed significantly with respect to descriptive variables, including mortality (range, 2.2% to 16.4%). Analysis of risk-adjusted mortality indicated that the hospital teaching status and the presence of a pediatric intensivist were significantly associated with a patient's chance of survival. The probability of patient survival after hospitalization in an ICU located in a teaching hospital was decreased (relative odds of dying, 1.79; 95% confidence interval [CI], 1.23 to 2.61; P = .002). In contrast, the probability of patient survival after hospitalization in an ICU with a pediatric intensivist was improved (relative odds of dying, 0.65; 95% CI, 0.44 to 0.95; P = .027). Post hoc analysis indicated that the higher severity-adjusted mortality in teaching hospitals may be explained by the presence of residents caring for ICU patients.


CONCLUSIONS
Characteristics indicative of the best overall hospital quality may not be associated, or may be negatively associated, with quality of care in specialized care areas, including the pediatric ICU.
Pollack
M M
MM
Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
Cuerdon
T T
TT
Patel
K M
KM
Ruttimann
U E
UE
Getson
P R
PR
Levetown
M
M
D002648:Child; D003625:Data Collection; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology