August 11, 2016
Hospitals that more frequently use intensive care units (ICUs) to treat select medical conditions are more likely to perform invasive procedures that incur a higher cost but do not improve hospital mortality compared to hospitals that use ICUs less frequently.
This is the finding of a retrospective cohort study that looked at whether 94 acute-care nonfederal hospitals in Washington state and Maryland between 2010 and 2012 had consistent patterns of ICU utilization for four common medical conditions, diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF). The main outcome of the study was the association between hospital-level ICU utilization rates and risk-adjusted hospital mortality, use of invasive procedures, and hospital costs.
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A total of 156,842 hospitalizations of patients identified with one of the four medical conditions were included in the study, representing 4.7% of total hospitalizations in the study.
The study found a range of ICU admission rates among the 94 hospitals. The ICU admission rate ranged from 16.3% to 81.2% for DKA, 5.0% to 44.2% for PE, 11.5% to 51.2% for UGIB, and 3.9% to 48.8% for CHF.
Using multilevel logistic regression models to determine the predicted ICU utilization among the hospitals during patient hospitalization for the four medical conditions, the study found similar ICU utilization patterns across the four medical conditions. This was based on statistical analyses that showed significant correlations in ICU utilization for all four medical conditions among the hospitals. According to the study authors, this suggested that decisions to potentially overutilize ICU care may be influenced by systematic institutional factors.
When assessing the main outcome of the study, the investigators found that hospitals with higher ICU utilization for all four medical conditions were associated with a greater use of invasive procedures and higher hospitalization costs, but no association with hospital mortality.
“Interventions that seek to improve the value of critical care services will need to address these factors that lead clinicians to admit patients to higher levels of care when equivalent care can be delivered elsewhere in the hospital,” conclude the authors.”
Chang DW, Shapiro MF. Association Between Intensive Care Unit Utilization During Hospitalization and Costs, Use of Invasive Procedures, and Mortality [published online ahead of print August 8, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.4298.