Use of intensive care-specific interventions in major teaching and other hospitals: a regional comparison.
OBJECTIVE
To compare the use of 40 specific medical interventions in intensive care units (ICUs) of major teaching and other hospitals


METHODS
Retrospective cohort study.


METHODS
Thirty-eight ICUs in 28 hospitals in a large metropolitan region.


METHODS
A total of 12,929 consecutive eligible admissions to medical, surgical, neurologic, or mixed medical/surgical ICUs between January 1, and June 30, 1994.


METHODS
The use of 40 diagnostic and therapeutic interventions during the first 24 hrs of ICU admission were obtained from patient medical records and a weighted intervention score was determined for each patient. Admission severity of illness was measured by using the Acute Physiology and Chronic Health Evaluation III methodology.


RESULTS
Patients at the five teaching hospitals had a greater severity of illness (mean predicted risk of in-hospital death, 15.1%+/-21.9% vs. 11.2%+/-19.0%; p < .01) than patients at the 23 other hospitals. Patients at major teaching hospitals also had higher mean intervention scores (3.5+/-4.9 vs. 2.3+/-3.7; p < .01). Differences in intervention scores persisted after controlling for severity of illness, admission diagnosis, and admission source. However, scores varied among the major teaching hospitals. When examined individually, only three of the five major teaching hospitals had higher (p < .05) interventions scores, compared with other hospitals, whereas one had a lower (p < .05) intervention score.


CONCLUSIONS
Patients in ICUs at major teaching hospitals were, in aggregate, more likely to receive diagnostic and therapeutic interventions than patients at other hospitals. Variation among major teaching hospitals suggests that factors other than teaching status also affect the use of these interventions.
Block
B M
BM
Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
Sirio
C A
CA
Cooper
G S
GS
DiGiuseppe
D L
DL
Rosenthal
G E
GE
D018806:APACHE; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016014:Linear Models; D009820:Ohio; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors