Assessing the impact of patient characteristics and process performance on rural intensive care unit hospital mortality rates

Hj, Jiang; Jf, Fieselmann; Hendryx, Michael; Mj, Bock; Jf, Fielselmann

doi:10.1097/00003246-199705000-00011

Cited by 6 publications

(2 citation statements)

References 20 publications

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“…[1][2][3] This variation may be related to differences in ICU structure and care processes. [4][5][6][7][8][9] To assess and improve the quality of care in ICUs, it is necessary to understand how ICU structure and care processes are related to clinical and economic outcomes. [10][11][12][13] We hypothesize that differences in organizational characteristics of ICUs are associated with significant differences in clinical and economic outcomes for patients undergoing high-risk surgical procedures that typically require postoperative care in an ICU.Abdominal aortic surgery is a relatively common procedure that is performed in a variety of acute care hospitals with different ICU organizational characteristics.…”

mentioning

confidence: 99%

Organizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery

Pronovost

Jenckes²,

Dorman³

et al. 1999

JAMA

611

129

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ORBIDITY AND MORTALity rates in intensive care units (ICUs) vary widely among institutions. [1][2][3] This variation may be related to differences in ICU structure and care processes. [4][5][6][7][8][9] To assess and improve the quality of care in ICUs, it is necessary to understand how ICU structure and care processes are related to clinical and economic outcomes. [10][11][12][13] We hypothesize that differences in organizational characteristics of ICUs are associated with significant differences in clinical and economic outcomes for patients undergoing high-risk surgical procedures that typically require postoperative care in an ICU.Abdominal aortic surgery is a relatively common procedure that is performed in a variety of acute care hospitals with different ICU organizational characteristics. Patients admitted for abdominal aortic surgery routinely require ICU admission because of high postoperative morbidity and mortal-Author Affiliations and Financial Disclosures are listed at the end of this article.

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mentioning

confidence: 99%

Organizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery

Pronovost

Jenckes²,

Dorman³

et al. 1999

JAMA

611

129

View full text Add to dashboard Cite

show abstract

“…The intervention followed medical record audits and included face-to-face provider feedback, written recommendations, reference articles, seminars and telephone consultations. Specific data describing the impact of patient characteristics and process performance on mortality rates have recently been published [8]. Data describing the specific effects of the outreach educational program on patient care processes and outcomes in the treatment group versus control group have also been published [9].…”

Section: Introductionmentioning

confidence: 99%

Mechanical ventilation in rural ICUs

et al. 1999

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Background:In recent years, rural hospitals have expanded their scope of specialized services, which has led to the development and staffing of rural intensive care units (ICUs). There is little information about the breadth, quality or outcomes of these services. This is particularly true for specialized ICU services such as mechanical ventilation, where little, if any, information exists specifically for rural hospitals. The long-term objectives of this project were to evaluate the quality of medical care provided to mechanically ventilated patients in rural ICUs and to improve patient care through an educational intervention. This paper reports baseline data on patient and hospital characteristics for both rural and rural referral hospitals.Results: Twenty Iowa hospitals were evaluated. Data collected on 224 patients demonstrated a mean age of 70 years and a mean ICU admission Acute Physiology and Chronic Health Evaluation (APACHE) II score of 22, with an associated 36% mortality. Mean length of ICU stay was 10 days, with 7.7 ventilated days. Significant differences were found in both institutional and patient variables between rural referral hospitals and rural hospitals with more limited resources. A subgroup of patients with diagnoses associated with complex ventilation had higher mortality rates than patients without these conditions. Patients who developed nosocomial events had longer mean ventilator and ICU days than patients without nosocomial events. This study also found ICU practices that frequently fell outside the guidelines recommended by a task force describing minimum standards of care for critically ill patients with acute respiratory failure on mechanical ventilation.Conclusions: Despite distinct differences in the available resources between rural referral and rural hospitals, overall mortality rates of ventilated patients are similar. Considering the higher mortality rates observed in patients with complicated medical conditions requiring complex ventilation management, the data may suggest that this subgroup could benefit from treatment at a tertiary center with greater resources and technology.

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The Organizational Structure of Intensive Care Units and its Influence on Patient Outcomes

Kutsogiannis

Hague

Triska³

et al. 2001

Healthc Manage Forum

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Despite the growing body of knowledge on the theory of organization, the application of such theory to the organization of intensive care units is in its infancy. Our knowledge about the influence of ICU organization on patient outcomes is limited. Development of instruments to measure ICU organization, and their implementation in studies of new therapies and technologies, will assist in demonstrating the effect of various models of ICU organization on the provision of clinical care.

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Assessing the impact of patient characteristics and process performance on rural intensive care unit hospital mortality rates

Abstract: Most of the variation in mortality was explained by differences in patient physiologic and demographic characteristics at ICU admission. After adjusting for patient characteristics, better performance in some processes of care would have significant impact on reducing risk of mortality.

Cited by 6 publications

References 20 publications

Organizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery

Organizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery

Mechanical ventilation in rural ICUs

The Organizational Structure of Intensive Care Units and its Influence on Patient Outcomes

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