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A revised method to assess intensive care unit clinical performance and resource utilization.

Brian H Nathanson¹, Thomas L Higgins, Daniel Teres

¹OptiStatim LLC, Longmeadow, MA, USA.

Critical Care Medicine

|June 15, 2007

Summary

This summary is machine-generated.

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A new Weighted Hospital Days (WHD) model and updated Rapoport-Teres graph were developed for benchmarking intensive care units (ICUs). This recalibrated tool provides a more accurate assessment of ICU performance using contemporary data.

Area of Science:

Critical Care Medicine
Health Services Research
Biostatistics

Background:

The original Rapoport-Teres graph, using the Mortality Probability Model (MPM0-II) and Weighted Hospital Days (WHD-94), is outdated.
Current data leads to an inflated assessment of intensive care unit (ICU) performance.
MPM0-II was updated to MPM0-III, but the WHD model requires revision.

Purpose of the Study:

To develop a new Weighted Hospital Days (WHD) model.
To revise the Rapoport-Teres graph for contemporary benchmarking.
To provide accurate ICU performance and resource utilization assessments.

Main Methods:

A multicenter cohort study involving 135 ICUs in 98 hospitals (Project IMPACT).
Data from 124,855 eligible patients treated between March 2001 and June 2004.

Related Experiment Videos

Stepwise linear regression used to build the WHD model predicting ICU-specific log average WHD from 39 variables.

Main Results:

WHD redefined: 4 units for the first ICU day, 2.5 for additional ICU days, 1 for non-ICU days post-discharge.
The new WHD model includes four predictors: percent of in-hospital deaths, unscheduled surgery, early mechanical ventilation, and discharge to post-acute care.
The model demonstrated good performance (R = 0.47) and, with MPM0-III, created a well-calibrated graph.

Conclusions:

A novel WHD model and updated Rapoport-Teres graph are presented, derived from a large critical care database.
This recalibrated tool offers an updated method for ICU benchmarking.
Users may observe a perceived decline in performance coordinates; focus should shift to relative peer performance.