A Colombian survey found intensive care mortality ratios were better in private vs. public hospitals.
BACKGROUND
Our main outcome was to identify organizational characteristics that help to evaluate the differences between the intensive care mortality ratios adjusted by APACHE II. We incorporated the variation associated with the ranking of institutions simulating its random effects under a binomial distribution.


METHODS
A nationwide survey on structure, technology, and staffing resources available in Colombian intensive care units during 1997-1998 was conducted. We collected data on admissions from 20 randomly selected adult medical and surgical intensive care units.


RESULTS
The mortality ratio from the 20 intensive care units ranged from 0.59 to 2.36; 80% of the intensive care units had a mortality ratio greater than 1. All four intensive care units with the lowest mortality ratio belonged to private institutions, while four of five institutions with the highest mortality belonged to the public sector. Intensive care units in private institutions also had fewer number of beds, lower median length of stay, lower occupancy rates, higher education training for specialists and nurses and fewer emergency nonelective surgical procedures.


CONCLUSIONS
We successfully accounted for intensive care mortality baseline differences and random effects variations. There were substantial differences between intensive care units in institution type, bed availability, technology, staffing resources, and degree of training, which may have been associated with patient outcome. These results are of crucial importance to track, detect and assess future changes.
Pérez
Adriana
A
Clinical Epidemiology and Biostatistics Unit, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. adriana.perez@uth.tmc.edu
Dennis
Rodolfo J
RJ
Rondón
Martin A
MA
Metcalfe
M Alison
MA
Rowan
Kathy M
KM
D000328:Adult; D001509:Bed Occupancy; D003105:Colombia / Q000453:epidemiology; D003422:Critical Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D004630:Emergencies; D019538:Health Care Surveys / Q000379:methods; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D016304:Hospitals, Private / Q000458:organization & administration / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007902:Length of Stay; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care / Q000379:methods