Physician-attributable differences in intensive care unit costs: a single-center study.
BACKGROUND
Variation in practice and outcomes, not explained by patient or illness characteristics, is common in health care, including in intensive care units (ICUs).


OBJECTIVE
To quantify within-ICU, between-physician variation in resource use in a single medical ICU.


METHODS
This was a prospective, noninterventional study in a medical ICU where nine intensivists provide care in 14-d rotations. Consecutive sample consisted of 1,184 initial patient admissions whose care was provided by a single intensivist. Multivariate models were constructed for average daily discretionary costs, ICU length of stay, and hospital mortality, adjusting for patient and illness characteristics, and workload.


RESULTS
The identity of the intensivist was a significant predictor for average daily discretionary costs (p < 0.0001), but not ICU length of stay (p = 0.33) or hospital mortality (p = 0.83). The intensivists had more influence on costs than all other variables except the severity and type of acute illness. Average daily discretionary costs varied by 43% across the different intensivists, equating to a mean difference of 1,003 dollars per admission between the highest and lowest terciles of intensivists.


CONCLUSIONS
There are large differences among intensivists in the amount of resources they use to manage critically ill patients. Higher resource use was not associated with lower length of stay or mortality.
Garland
Allan
A
Division of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA. agarland@metrohealth.org
Shaman
Ziad
Z
Baron
John
J
Connors
Alfred F
AF
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003422:Critical Care / Q000191:economics*; D005260:Female; D006295:Health Resources / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011446:Prospective Studies; D016526:Workload