Methodological approach for the evaluation of the performances of medical intensive care units

• Published in: Journal of critical care 2007-09, Vol.22 (3), p.184-190
• Main Authors: Hubert, Hervé, PhD, Guinhouya, Comlavi, PhD, Castra, Laurent, MSc, Soubrier, Stéphane, MD, MSc, Vilhelm, Christian, PhD, Ravaux, Pierre, PhD, Lemdani, Mohamed, PhD, Durocher, Alain, MD, PhD, Saulnier, Fabienne, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Critical Care; Critical Care - economics; Critical Care - organization & administration; Critical Care - standards; Economic performance; Female; Forecasting; France; Health Resources - utilization; Hospital Mortality; Humans; Intensive care; Intensive care units; Intensive Care Units - economics; Intensive Care Units - organization & administration; Intensive Care Units - standards; Linear Models; Male; Middle Aged; Models, Theoretical; Mortality; Multivariate Analysis; Patients; Physiology; Prospective Studies; Quality Assurance, Health Care - economics; Quality Assurance, Health Care - methods; Resource consumption; Risk Adjustment; Simplified Acute Physiology Score version 2; Workload; Workloads
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2006.11.007

Abstract Purpose The purpose of the study was to present a methodological approach enabling the comparison of clinical and economic performances of intensive care units and a graphical visualization based on these 2 dimensions. Patients and Methods A retrospective analysis of a database of 666 patients admitted in intensive care units over a period of 2 consecutive months. Results Calculation of clinical performance is based on the difference between the mortality observed and forecast from the Simplified Acute Physiology Score version 2. The evaluation of resource consumption is carried out from the measure of medical and paramedical care workload. These 2 scores are modeled on the basis of the length of stay and the severity state of the patient. The economic performance is calculated on the basis of the difference between the resource consumption observed and forecast. The graphs are constructed by taking up as coordinates the values of the clinical and economic performances of each center. Conclusion These graphs enable the identification of the most deviating intensive care units to study, for example, their organizational, technical, or human resource setup accounting for their position.