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Related Experiment Videos

Evaluating outcome from intensive care: a preliminary multihospital comparison

W A Knaus, E A Draper, D P Wagner

    Critical Care Medicine
    |August 1, 1982
    PubMed
    Summary

    Comparing intensive care unit (ICU) patient mortality across hospitals is complex. Severity of illness adjustments revealed similar observed and projected death rates, suggesting a valid method for interhospital outcome comparisons.

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    Area of Science:

    • Critical Care Medicine
    • Health Services Research
    • Biostatistics

    Background:

    • Interhospital comparisons of patient outcomes are crucial for quality assessment.
    • Variations in patient severity of illness can confound outcome comparisons.
    • Standardized methods are needed to adjust for differences in patient populations.

    Purpose of the Study:

    • To evaluate the effectiveness of a general severity of illness classification system in comparing mortality rates across different intensive care units (ICUs).
    • To assess the accuracy of projected death rates against observed mortality in multiple ICUs.

    Main Methods:

    • Surveyed 795 consecutive ICU admissions across 5 ICUs.
    • Collected patient data including age, sex, admission indication, and severity of illness.

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  • Utilized a logistic multiple regression equation, calibrated with data from a sixth reference hospital, to project death rates.

    • Main Results:

    • Significant differences in patient severity of acute illness were identified among the hospitals.
    • These severity differences accounted for the majority of the variation in observed death rates.
    • Projected death rates closely matched observed deaths in all evaluated ICUs.

    Conclusions:

    • A general severity of illness index, when combined with multivariate statistical techniques, shows promise for improving interhospital outcome comparisons.
    • Further refinement and validation are recommended for this approach.
    • This methodology can aid in more equitable assessments of ICU performance.