Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism

Andrew J. Admon, Christopher W. Seymour, Hayley B. Gershengorn, Hannah Wunsch, Colin R. Cooke

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND: Variation in the use of ICUs for low-risk conditions contributes to health system inefficiency. We sought to examine the relationship between ICU use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use.

METHODS: We performed a retrospective cohort study including 61,249 adults with PE discharged from 263 hospitals in three states between 2007 and 2010. We generated hospital-specific ICU admission rate quartiles and used a series of multilevel models to evaluate relationships between admission rates and risk-adjusted in-hospital mortality, readmission, and costs and between ICU admission rates and several critical care procedures.

RESULTS: Hospital quartiles varied in unadjusted ICU admission rates for PE (range, ≤ 15% to > 31%). Among all patients, there was a small trend toward increased use of arterial catheterization (0.6%-1.1%, P <.01) in hospital quartiles with higher levels of ICU admission. However, use of invasive mechanical ventilation (14.4%-7.9%, P <.01), noninvasive ventilation (6.6%-3.0%, P <.01), central venous catheterization (14.6%-11.3%, P <.02), and thrombolytics (11.0%-4.7%, P <.01) in patients in the ICU declined across hospital quartiles. There was no relationship between ICU admission rate and risk-adjusted hospital mortality, costs, or readmission.

CONCLUSIONS: Hospitals vary widely in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission. Patients admitted to ICUs in higher-using hospitals received many critical care procedures less often, suggesting that these patients may have had weaker indications for ICU admission. Hospitals with greater ICU admission may be appropriate targets for improving efficiency in ICU admissions.

Original languageEnglish (US)
Pages (from-to)1452-1461
Number of pages10
JournalChest
Volume146
Issue number6
DOIs
StatePublished - Dec 1 2014

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Critical Care
Pulmonary Embolism
Patient Readmission
Hospital Costs
Hospital Mortality
Central Venous Catheterization
Costs and Cost Analysis
Noninvasive Ventilation
Mortality
Artificial Respiration
Catheterization
Cohort Studies
Retrospective Studies
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Admon, A. J., Seymour, C. W., Gershengorn, H. B., Wunsch, H., & Cooke, C. R. (2014). Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism. Chest, 146(6), 1452-1461. https://doi.org/10.1378/chest.14-0059

Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism. / Admon, Andrew J.; Seymour, Christopher W.; Gershengorn, Hayley B.; Wunsch, Hannah; Cooke, Colin R.

In: Chest, Vol. 146, No. 6, 01.12.2014, p. 1452-1461.

Research output: Contribution to journalArticle

Admon, Andrew J. ; Seymour, Christopher W. ; Gershengorn, Hayley B. ; Wunsch, Hannah ; Cooke, Colin R. / Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism. In: Chest. 2014 ; Vol. 146, No. 6. pp. 1452-1461.
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abstract = "BACKGROUND: Variation in the use of ICUs for low-risk conditions contributes to health system inefficiency. We sought to examine the relationship between ICU use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use.METHODS: We performed a retrospective cohort study including 61,249 adults with PE discharged from 263 hospitals in three states between 2007 and 2010. We generated hospital-specific ICU admission rate quartiles and used a series of multilevel models to evaluate relationships between admission rates and risk-adjusted in-hospital mortality, readmission, and costs and between ICU admission rates and several critical care procedures.RESULTS: Hospital quartiles varied in unadjusted ICU admission rates for PE (range, ≤ 15{\%} to > 31{\%}). Among all patients, there was a small trend toward increased use of arterial catheterization (0.6{\%}-1.1{\%}, P <.01) in hospital quartiles with higher levels of ICU admission. However, use of invasive mechanical ventilation (14.4{\%}-7.9{\%}, P <.01), noninvasive ventilation (6.6{\%}-3.0{\%}, P <.01), central venous catheterization (14.6{\%}-11.3{\%}, P <.02), and thrombolytics (11.0{\%}-4.7{\%}, P <.01) in patients in the ICU declined across hospital quartiles. There was no relationship between ICU admission rate and risk-adjusted hospital mortality, costs, or readmission.CONCLUSIONS: Hospitals vary widely in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission. Patients admitted to ICUs in higher-using hospitals received many critical care procedures less often, suggesting that these patients may have had weaker indications for ICU admission. Hospitals with greater ICU admission may be appropriate targets for improving efficiency in ICU admissions.",
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AU - Cooke, Colin R.

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N2 - BACKGROUND: Variation in the use of ICUs for low-risk conditions contributes to health system inefficiency. We sought to examine the relationship between ICU use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use.METHODS: We performed a retrospective cohort study including 61,249 adults with PE discharged from 263 hospitals in three states between 2007 and 2010. We generated hospital-specific ICU admission rate quartiles and used a series of multilevel models to evaluate relationships between admission rates and risk-adjusted in-hospital mortality, readmission, and costs and between ICU admission rates and several critical care procedures.RESULTS: Hospital quartiles varied in unadjusted ICU admission rates for PE (range, ≤ 15% to > 31%). Among all patients, there was a small trend toward increased use of arterial catheterization (0.6%-1.1%, P <.01) in hospital quartiles with higher levels of ICU admission. However, use of invasive mechanical ventilation (14.4%-7.9%, P <.01), noninvasive ventilation (6.6%-3.0%, P <.01), central venous catheterization (14.6%-11.3%, P <.02), and thrombolytics (11.0%-4.7%, P <.01) in patients in the ICU declined across hospital quartiles. There was no relationship between ICU admission rate and risk-adjusted hospital mortality, costs, or readmission.CONCLUSIONS: Hospitals vary widely in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission. Patients admitted to ICUs in higher-using hospitals received many critical care procedures less often, suggesting that these patients may have had weaker indications for ICU admission. Hospitals with greater ICU admission may be appropriate targets for improving efficiency in ICU admissions.

AB - BACKGROUND: Variation in the use of ICUs for low-risk conditions contributes to health system inefficiency. We sought to examine the relationship between ICU use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use.METHODS: We performed a retrospective cohort study including 61,249 adults with PE discharged from 263 hospitals in three states between 2007 and 2010. We generated hospital-specific ICU admission rate quartiles and used a series of multilevel models to evaluate relationships between admission rates and risk-adjusted in-hospital mortality, readmission, and costs and between ICU admission rates and several critical care procedures.RESULTS: Hospital quartiles varied in unadjusted ICU admission rates for PE (range, ≤ 15% to > 31%). Among all patients, there was a small trend toward increased use of arterial catheterization (0.6%-1.1%, P <.01) in hospital quartiles with higher levels of ICU admission. However, use of invasive mechanical ventilation (14.4%-7.9%, P <.01), noninvasive ventilation (6.6%-3.0%, P <.01), central venous catheterization (14.6%-11.3%, P <.02), and thrombolytics (11.0%-4.7%, P <.01) in patients in the ICU declined across hospital quartiles. There was no relationship between ICU admission rate and risk-adjusted hospital mortality, costs, or readmission.CONCLUSIONS: Hospitals vary widely in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission. Patients admitted to ICUs in higher-using hospitals received many critical care procedures less often, suggesting that these patients may have had weaker indications for ICU admission. Hospitals with greater ICU admission may be appropriate targets for improving efficiency in ICU admissions.

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