Hospital-Level Variation in the Use of Intensive Care
Article first published online: 30 MAR 2012
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 5, pages 2060–2080, October 2012
How to Cite
Seymour, C. W., Iwashyna, T. J., Ehlenbach, W. J., Wunsch, H. and Cooke, C. R. (2012), Hospital-Level Variation in the Use of Intensive Care. Health Services Research, 47: 2060–2080. doi: 10.1111/j.1475-6773.2012.01402.x
- Issue published online: 17 SEP 2012
- Article first published online: 30 MAR 2012
- National Center for Research Resources. Grant Number: KL2 RR025015
- National Institutes on Aging. Grant Number: K08AG038477
- National Heart, Lung, and Blood Insitute. Grant Number: K08HL091249-01
Vol. 48, Issue 2pt1, 681, Article first published online: 8 MAR 2013
- Intensive care;
- critical illness;
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.
Hospital discharge data in the State Inpatient Database for Maryland and Washington States in 2006.
Cross-sectional analysis of 90 short-term, acute care hospitals with critical care capabilities.
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.
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).
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.