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An Evaluation of Outcome from Intensive Care in Major Medical Centers

[+] Article, Author, and Disclosure Information

Grant support: in part by grants #HS 04857 from the National Center for Health Services Research, Office of the Assistant Secretary for Health, and #8498 from the Robert Wood Johnson Foundation, Princeton, New Jersey.

The opinions, conclusions, and proposals in the text are those of the authors and do not necessarily represent views of the sponsoring agencies.

▸Requests for reprints should be addressed to William A. Knaus, M.D.; ICU Research Unit, 2300 K Street, N.W.; Washington, DC 20037.

Washington, D.C.

© 1986 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1986;104(3):410-418. doi:10.7326/0003-4819-104-3-410
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We prospectively studied treatment and outcome in 5030 patients in intensive care units at 13 tertiary care hospitals. We stratified each hospital's patients by individual risk of death using diagnosis, indication for treatment, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. We then compared actual and predicted death rates using group results as the standard. One hospital had significantly better results with 69 predicted but 41 observed deaths (p < 0.0001). Another hospital had significantly inferior results with 58% more deaths than expected (p < 0.0001). These differences occurred within specific diagnostic categories, for medical patients alone and for medical and surgical patients combined, and were related more to the interaction and coordination of each hospital's intensive care unit staff than to the unit's administrative structure, amount of specialized treatment used, or the hospital's teaching status. Our findings support the hypothesis that the degree of coordination of intensive care significantly influences its effectiveness.





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