Case-mix-adjusted length of stay and mortality in 23 Finnish ICUs.
OBJECTIVE
To create a tool for benchmarking intensive care units (ICUs) with respect to case-mix adjusted length of stay (LOS) and to study the association between clinical and economic measures of ICU performance.


METHODS
Observational cohort study.


METHODS
Twenty-three ICUs in Finland.


METHODS
A total of 80,854 consecutive ICU admissions during 2000-2005, of which 63,304 met the inclusion criteria.


METHODS
None.


RESULTS
Linear regression was used to create a model that predicted ICU LOS. Simplified Acute Physiology Score (SAPS) II, age, disease categories according to Acute Physiology and Chronic Health Evaluation III, single highest Therapeutic Intervention Scoring System score collected during the ICU stay and presence of other ICUs in the hospital were included in the model. Probabilities of hospital death were calculated using SAPS II, age, and disease categories as covariates. In the validation sample, the created model accounted for 28% of variation in ICU LOS across individual admissions and 64% across ICUs. The expected ICU LOS was 2.53 +/- 2.24 days and the observed ICU LOS was 3.29 +/- 5.37 days, P < 0.001. There was no association between the mean observed - mean expected ICU LOS and standardized mortality ratios of the ICUs (Spearman correlation 0.091, P = 0.680).


CONCLUSIONS
We developed a tool for the assessment of resource use in a large nationwide ICU database. It seems that there is no association between clinical and economic quality indicators.
Niskanen
Minna
M
Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland. minnaliisa.niskanen@kuh.fi
Reinikainen
Matti
M
Pettilä
Ville
V
D000328:Adult; D000368:Aged; D019985:Benchmarking; D015331:Cohort Studies; D005387:Finland / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016014:Linear Models; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D020379:Risk Adjustment