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dc.contributor.authorViglianti, EM
dc.contributor.authorBagshaw, SM
dc.contributor.authorBellomo, R
dc.contributor.authorMcPeake, J
dc.contributor.authorWang, XQ
dc.contributor.authorSeelye, S
dc.contributor.authorIwashyna, TJ
dc.date.accessioned2020-12-14T06:01:37Z
dc.date.available2020-12-14T06:01:37Z
dc.date.issued2020-06-04
dc.identifierpii: 10.1007/s00134-020-06129-9
dc.identifier.citationViglianti, E. M., Bagshaw, S. M., Bellomo, R., McPeake, J., Wang, X. Q., Seelye, S. & Iwashyna, T. J. (2020). Hospital-level variation in the development of persistent critical illness. INTENSIVE CARE MEDICINE, 46 (8), pp.1567-1575. https://doi.org/10.1007/s00134-020-06129-9.
dc.identifier.issn0342-4642
dc.identifier.urihttp://hdl.handle.net/11343/254081
dc.description.abstractPURPOSE: Patients with persistent critical illness may account for up to half of all intensive care unit (ICU) bed-days. It is unknown if there is hospital variation in the development of persistent critical illness and if hospital performance affects the incidence of persistent critical illness. METHODS: This is a retrospective analysis of Veterans admitted to the Veterans Administration (VA) ICUs from 2015 to 2017. Hospital performance was defined by the risk- and reliability-adjusted 30-day mortality. Persistent critical illness was defined as an ICU length of stay of at least 11 days. We used 2-level multilevel logistic regression models to assess variation in risk- and reliability-adjusted probabilities in the development of persistent critical illness. RESULTS: In the analysis of 100 hospitals which encompassed 153,512 hospitalizations, 4.9% (N = 7640/153,512) developed persistent critical illness. There was variation in the development of persistent critical illness despite controlling for patient characteristics (intraclass correlation: 0.067, 95% CI 0.049-0.091). Hospitals with higher risk- and reliability-adjusted 30-day mortality had higher probabilities of developing persistent critical illness (predicted probability: 0.057, 95% CI 0.051-0.063, p < 0.01) compared to those with lower risk- and reliability-adjusted 30-day mortality (predicted probability: 0.046, 95% CI 0.041-0.051, p < 0.01). The median odds ratio was 1.4 (95% CI 1.33-1.49) implying that, for two patients with the same physiology on admission at two different VA hospitals, the patient admitted to the hospital with higher adjusted mortality would have 40% greater odds of developing persistent critical illness. CONCLUSION: Hospitals with higher risk- and reliability-adjusted 30-day mortality have a higher probability of developing persistent critical illness. Understanding the drivers of this variation may identify modifiable factors contributing to the development of persistent critical illness.
dc.languageEnglish
dc.publisherSPRINGER
dc.titleHospital-level variation in the development of persistent critical illness
dc.typeJournal Article
dc.identifier.doi10.1007/s00134-020-06129-9
melbourne.affiliation.departmentCritical Care
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titleIntensive Care Medicine
melbourne.source.volume46
melbourne.source.issue8
melbourne.source.pages1567-1575
melbourne.elementsid1451879
melbourne.openaccess.urlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444658
melbourne.openaccess.statusAccepted version
melbourne.contributor.authorBellomo, Rinaldo
dc.identifier.eissn1432-1238
melbourne.accessrightsAccess this item via the Open Access location


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