title: Effect of certified training facilities for intensive care specialists on mortality in Japan.
abstract: OBJECTIVE
  To compare patient outcomes in hospitals certified by the Japanese Society of Intensive Care Medicine (JSICM) as training facilities for intensive care specialists with patient outcomes in hospitals not certified by the JSICM (non-CFs).
  
  
  METHODS
  A retrospective case-control study using administrative data.
  
  
  METHODS
  Inhospital mortality.
  
  
  RESULTS
  164 803 intensive care unit admissions were identified between 1 April 2008 and 31 March 2010, of which 159 540 were for adults (≥18 years). A total of 50 875 patients in 125 hospitals were admitted to certified facilities (CFs) and 108 665 patients in 309 hospitals were admitted to non-CFs. Inhospital mortality rates were 9.9% and 10.6% in CFs and non-CFs, respectively (P < 0.001). After adjusting for age, emergency admission, admission route, use of vasopressors, mechanical ventilation, and renal replacement therapy, the odds ratio for hospital mortality in CF-treated patients was 0.81 (95% confidence interval, 0.78-0.85). The c statistic of the model was 0.881.
  
  
  CONCLUSIONS
  Patients admitted to the intensive care unit in CFs had better outcomes. To improve patient outcomes, more board-certified intensivists are required in Japan.
authors: Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Kazuto
authors: K
authors: Yamashita
authors: Hiroshi
authors: H
authors: Ikai
authors: Masaji
authors: M
authors: Nishimura
authors: Kiyohide
authors: K
authors: Fushimi
authors: Yuichi
authors: Y
authors: Imanaka
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002568:Certification; D003422:Critical Care; D004503:Education, Medical, Graduate; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007564:Japan; D008297:Male; D008511:Medicine; D012189:Retrospective Studies