title: Hospital-level variation in the use of intensive care.
abstract: OBJECTIVE
  To determine the extent to which hospitals vary in the use of intensive care, and the proportion of variation attributable to differences in hospital practice that is independent of known patient and hospital factors.
  
  
  METHODS
  Hospital discharge data in the State Inpatient Database for Maryland and Washington States in 2006.
  
  
  METHODS
  Cross-sectional analysis of 90 short-term, acute care hospitals with critical care capabilities. DATA COLLECTION/METHODS: We quantified the proportion of variation in intensive care use attributable to hospitals using intraclass correlation coefficients derived from mixed-effects logistic regression models after successive adjustment for known patient and hospital factors.
  
  
  RESULTS
  The proportion of hospitalized patients admitted to an intensive care unit (ICU) across hospitals ranged from 3 to 55 percent (median 12 percent; IQR: 9, 17 percent). After adjustment for patient factors, 19.7 percent (95 percent CI: 15.1, 24.4) of total variation in ICU use across hospitals was attributable to hospitals. When observed hospital characteristics were added, the proportion of total variation in intensive care use attributable to unmeasured hospital factors decreased by 26-14.6 percent (95 percent CI: 11, 18.3 percent).
  
  
  CONCLUSIONS
  Wide variability exists in the use of intensive care across hospitals, not attributable to known patient or hospital factors, and may be a target to improve efficiency and quality of critical care.
authors.affiliation: Departments of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Core Faculty, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, 639 Scaife Hall 3550 Terrace Street, Pittsburgh, PA 15261, USA. seymourcw@upmc.edu
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seymour
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.forename: William J
authors.initials: WJ
authors.lastname: Ehlenbach
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D014861:Washington