Patient characteristics and ICU organizational factors that influence frequency of pulmonary artery catheterization.
BACKGROUND
Hemodynamic monitoring of patients with a pulmonary artery catheter is controversial because there are few data confirming its effectiveness, and patient and intensive care unit (ICU) organizational factors associated with its use are unknown.


OBJECTIVE
To determine pulmonary artery catheter use in relationship to type of ICU organization and staffing, and patient characteristics, including severity of illness and insurance coverage.


METHODS
Retrospective database study of 10,217 nonoperative patients who received treatment at 34 medical, mixed medical and surgical, and surgical ICUs at 27 hospitals during 1998 (patients were enrolled in Project IMPACT).


METHODS
Pulmonary artery catheter use based on severity of illness measured by the Simplified Acute Physiology Score, resuscitation status at ICU admission, and ICU organizational variables, including type, size, and model.


RESULTS
A pulmonary artery catheter was used for 831 patients (8.1%) in the ICU. In multivariate analysis adjusted for severity of illness, age, diagnosis, and do-not-resuscitate status, full-time ICU physician staffing was associated with a two-thirds reduction in the probability of catheter use (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.28-0.45). Higher catheter use was associated with white race (OR, 1.38; 95% CI, 1.10-1.72) and private insurance coverage (OR, 1.33; 95% CI, 1.10-1.60). Admission to a surgical ICU was associated with a 2-fold increase in probability of catheter use (OR, 2.17; 95% CI, 1.70-2.76) compared with either medical or mixed medical and surgical ICUs.


CONCLUSIONS
Organizational characteristics of ICUs, insurance reimbursement, and race, as well as clinical variables, are associated with variation in practice patterns regarding pulmonary artery catheter use. Understanding such influences, combined with studies measuring clinical and economic outcomes, can contribute to the development of policies for the rational use of pulmonary artery catheters. JAMA. 2000;283:2559-2567
Rapoport
J
J
Mount Holyoke College, 50 College St, South Hadley, MA 01075, USA. rapoport@mtholyoke.edu
Teres
D
D
Steingrub
J
J
Higgins
T
T
McGee
W
W
Lemeshow
S
S
D000328:Adult; D000368:Aged; D002407:Catheterization, Swan-Ganz / Q000706:statistics & numerical data*; D003422:Critical Care; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007362:Intensive Care Units / Q000458:organization & administration*; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States