OBJECTIVE: The organizational structure of health care facilities has been shown to affect outcome in critically ill patients. We evaluated the association between structures, treatments and outcomes in a large cohort of critically ill patients. DESIGN: Prospective multicentre cohort study. PATIENTS AND SETTING: A total of 26,186 patients consecutively admitted to 31 intensive care units (ICUs) in Austria from January 1998 through December 2000. MEASUREMENTS AND RESULTS: The ICUs were divided into three groups according to the size and function of the hospital: community hospitals and specialized trauma centers (group A); central referral hospitals (group B); and teaching hospitals (group C). Group C patients exhibited a significantly higher risk-adjusted mortality (O/E ratio). Although severity of illness at admission in groups B and C was similar, group C patients received significantly more invasive diagnostic and therapeutic interventions throughout their ICU stay: For 7 of 10 invasive interventions identified, odds ratios for group C vs group B patients were significantly increased, even after adjustment for age, gender, severity of illness and reason for admission (odds ratios 1.2-13.1; all 95% CIs >1). Risk-adjusted multivariate analysis confirmed that six of these invasive interventions were independently associated with mortality. Furthermore, nurse-to-patient ratios did not differ between groups, leading to a significantly increased nursing workload in group C ICUs. CONCLUSIONS: Several invasive interventions were independently associated with increased mortality. Our results provide strong evidence that this association was responsible in part for the increased risk-adjusted mortality in group C patients.
OBJECTIVE: The organizational structure of health care facilities has been shown to affect outcome in critically illpatients. We evaluated the association between structures, treatments and outcomes in a large cohort of critically illpatients. DESIGN: Prospective multicentre cohort study. PATIENTS AND SETTING: A total of 26,186 patients consecutively admitted to 31 intensive care units (ICUs) in Austria from January 1998 through December 2000. MEASUREMENTS AND RESULTS: The ICUs were divided into three groups according to the size and function of the hospital: community hospitals and specialized trauma centers (group A); central referral hospitals (group B); and teaching hospitals (group C). Group C patients exhibited a significantly higher risk-adjusted mortality (O/E ratio). Although severity of illness at admission in groups B and C was similar, group C patients received significantly more invasive diagnostic and therapeutic interventions throughout their ICU stay: For 7 of 10 invasive interventions identified, odds ratios for group C vs group B patients were significantly increased, even after adjustment for age, gender, severity of illness and reason for admission (odds ratios 1.2-13.1; all 95% CIs >1). Risk-adjusted multivariate analysis confirmed that six of these invasive interventions were independently associated with mortality. Furthermore, nurse-to-patient ratios did not differ between groups, leading to a significantly increased nursing workload in group C ICUs. CONCLUSIONS: Several invasive interventions were independently associated with increased mortality. Our results provide strong evidence that this association was responsible in part for the increased risk-adjusted mortality in group C patients.
Authors: J Rello; J A Paiva; J Baraibar; F Barcenilla; M Bodi; D Castander; H Correa; E Diaz; J Garnacho; M Llorio; M Rios; A Rodriguez; J Solé-Violán Journal: Chest Date: 2001-09 Impact factor: 9.410
Authors: Andrés Esteban; Antonio Anzueto; Fernando Frutos; Inmaculada Alía; Laurent Brochard; Thomas E Stewart; Salvador Benito; Scott K Epstein; Carlos Apezteguía; Peter Nightingale; Alejandro C Arroliga; Martin J Tobin Journal: JAMA Date: 2002-01-16 Impact factor: 56.272
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Authors: P G Metnitz; H Vesely; A Valentin; C Popow; M Hiesmayr; K Lenz; C G Krenn; H Steltzer Journal: Crit Care Med Date: 1999-08 Impact factor: 7.598
Authors: P J Pronovost; M W Jenckes; T Dorman; E Garrett; M J Breslow; B A Rosenfeld; P A Lipsett; E Bass Journal: JAMA Date: 1999-04-14 Impact factor: 56.272
Authors: Rui P Moreno; Helene Hochrieser; Barbara Metnitz; Peter Bauer; Philipp G H Metnitz Journal: Intensive Care Med Date: 2010-03-20 Impact factor: 17.440
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerome Pugin; Michael Pinsky; Peter Radermacher; Christian Richard; Robert Tasker; Benoit Vallet Journal: Intensive Care Med Date: 2005-02-18 Impact factor: 17.440
Authors: Barbara Metnitz; Eva Schaden; Rui Moreno; Jean-Roger Le Gall; Peter Bauer; Philipp G H Metnitz Journal: Intensive Care Med Date: 2008-10-10 Impact factor: 17.440
Authors: Philipp G H Metnitz; Rui P Moreno; Eduardo Almeida; Barbara Jordan; Peter Bauer; Ricardo Abizanda Campos; Gaetano Iapichino; David Edbrooke; Maurizia Capuzzo; Jean-Roger Le Gall Journal: Intensive Care Med Date: 2005-08-17 Impact factor: 17.440