Abstract:
BACKGROUND:Although patients readmitted to intensive care units (ICUs) typically have poor outcomes, ICU readmission rates have not been studied as a measure of hospital performance. OBJECTIVES:To determine variation in ICU readmission rates across hospitals and associations of readmission rates with other ICU-based measures of hospital performance. RESEARCH DESIGN:Observational cohort study. SUBJECTS:One hundred three thousand nine hundred eighty four consecutive ICU patients who were admitted to twenty eight hospitals who were then transferred to a hospital ward in those 28 hospitals. MEASURES:Predicted risk of in-hospital death and ICU length of stay (LOS) were determined by a validated method based on age, ICU admission source, diagnosis, comorbidity, and physiologic abnormalities. Severity-adjusted mortality rates, LOS, and readmission rates were determined for each hospital. RESULTS:One or more ICU readmissions occurred in 5.8% patients who were initially classified as postoperative and in 6.4% patients who were initially classified as nonoperative. In-hospital mortality rate was 24.7% in patients who were readmitted as compared with 4.0% in other patients (P < 0.001). After adjusting for predicted risk of death, the odds of death remained 7.5 times higher (OR 7.5, 95% CI, 6.8-8.3). Readmitted patients also had longer (P < 0.001) ICU LOS (5.2 vs. 3.7 days) and hospital LOS (29.3 vs. 11.7 days). Severity-adjusted readmission rates varied across hospitals from 4.2% to 7.6%. Readmission rates were not correlated with severity-adjusted hospital mortality, ICU LOS, or hospital LOS. CONCLUSIONS:ICU patients who were subsequently readmitted have a higher risk of death and longer LOS after adjusting for severity of illness. However, readmission rates were not associated with severity-adjusted mortality or LOS. Those data indicate that ICU readmission may capture other aspects of hospital performance and may be complementary to these measures.
journal_name
Med Carejournal_title
Medical careauthors
Cooper GS,Sirio CA,Rotondi AJ,Shepardson LB,Rosenthal GEdoi
10.1097/00005650-199904000-00009keywords:
subject
Has Abstractpub_date
1999-04-01 00:00:00pages
399-408issue
4eissn
0025-7079issn
1537-1948journal_volume
37pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:OBJECTIVE:To assess drug prescribing by primary care physicians in France for various types of conditions, and to identify patterns and risk factors for poor prescribing quality. METHODS:The orders (n = 23,080) written for patients with five target diseases (acute nasopharyngitis, acute tonsillitis, essential hyperten...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199912000-00012
更新日期:1999-12-01 00:00:00
abstract:BACKGROUND:The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. OBJECTIVES:We investigated the relation...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199912000-00002
更新日期:1999-12-01 00:00:00
abstract:BACKGROUND:Prescription of new drugs contributes to substantial increases in annual drug expenditures. A small proportion of physicians appear to be early users of new prescription drugs and little is known about their characteristics. OBJECTIVE:To estimate the initial utilization rate of new prescription drugs among ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200308000-00004
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Failure to rescue (FTR), the rate of death in patients suffering 1 of 6 in-hospital complications, is an Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator calculated from administrative data. OBJECTIVE:: We sought to assess the accuracy of the AHRQ FTR algorithm. METHODS:We underto...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000250226.33094.d4
更新日期:2007-04-01 00:00:00
abstract::The purpose of this paper is to provide a systematic explanation of the use of traditional medicine among the native American population living in the San Francisco Bay area. Several hypotheses concerning the factors associated with this behavior are tested. These include tribal grouping, socioeconomic and sociocultur...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197511000-00004
更新日期:1975-11-01 00:00:00
abstract::In recent years, employers, insurers, and government purchasers have paid increased attention to the measurement of patient outcomes and health status. Such interest is stimulated less by policy or quality concerns than by the need to reduce health care expenditures. Any expected benefits which might accrue from healt...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199205001-00006
更新日期:1992-05-01 00:00:00
abstract::A population-based, retrospective analysis of Medicare Part A and Blue Cross hospital insurance claims data was used to determine whether hospice home care cost savings to third-party insurers are substantial and result from the substitution of less expensive home care visits for more costly hospital inpatient days. T...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198408000-00002
更新日期:1984-08-01 00:00:00
abstract:BACKGROUND:Latinos make up the largest group of minority children in the United States. Despite great diversity among Latino children, studies have traditionally treated them as a monolithic group. Few studies have examined patterns and determinants of access to and use of health care for different subgroups of Latino ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318190d9e4
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVES:To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. DATA AND STUDY POPULATION: The 1999-2009 nationwide Minimum Data Sets were linked with Online Survey of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182881cb0
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:This study uses empirical data to study changes in the structure and use of HMO hospital provider networks in California. STUDY DESIGN:Data from California HMOs are used to test whether there have been structural changes in HMO size, geographic coverage, hospital network design, and patient channeling for in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181589bcb
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine the dimensions of physician work satisfaction across a variety of medical specialties and practice settings. METHODS:A modified version of the Scheckler et al survey instrument was mailed to all physicians in Marion County, Indiana. Forty-two percent (777) of the eli...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199804000-00016
更新日期:1998-04-01 00:00:00
abstract::Patient care classification in Canada in the past has been largely dictated by insurance coverage and the fiscal policies of the individual provinces. In recent years, however, the Canadian Department of Health and Welfare has been promoting the development of a standard patient care classification based on assessment...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197605001-00021
更新日期:1976-05-01 00:00:00
abstract:BACKGROUND:Although the Affordable Care Act has been successful in expanding Medicaid to >17 million people, insurance alone may not translate into access to health care. Even among the insured, substantial barriers to accessing services inhibit health care utilization. OBJECTIVES:We examined the effect of selected ba...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000644
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. OBJE...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/mlr.0b013e3181cafbe3
更新日期:2010-04-01 00:00:00
abstract::The study determined the intrarelationships and interrelationships of two sets of physician performance measures: technical quality and utilization of medical resources. The performance measures were based on 2,431 episodes in 15 diagnostic categories involving 454 physicians. A series of correlations were used to det...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1978-06-01 00:00:00
abstract:BACKGROUND:The variability in preferences used in quality-adjusted life-years estimation jeopardizes the comparability of cost-effectiveness analyses and has led the Panel on Cost-Effectiveness in Health and Medicine (the PCEHM) to call for a catalog of "off-the-shelf" preference weights associated with conditions that...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000172050.67085.4f
更新日期:2005-07-01 00:00:00
abstract:INTRODUCTION:Growing adoption of electronic health records and increased emphasis on the reuse and integration of clinical care and administration data require a robust informatics infrastructure to inform health care effectiveness in real-world settings. The Scalable Architecture for Federated Translational Inquiries ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318259bff4
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:To examine the effects of health plan enrollment [health maintenance organizations (HMO) or fee-for-service (FFS)], a change in Medicare reimbursement policy which allowed for annual rather than biennial mammograms, and Health Plan Employer Data Information Set (HEDIS) measures on stage at diagnosis among old...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3180616c51
更新日期:2007-08-01 00:00:00
abstract::The application of analytical and interactive decision models to decisions, in EMS councils, with various levels of uncertainty is described. Uncertainty is defined as having temporal, procedural, quantifiability, and environmental attributes. Highly uncertain decisions are unique, with unknown decision procedures. De...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197902000-00005
更新日期:1979-02-01 00:00:00
abstract::Disparities by economic status are observed in the health status and health outcomes of Medicare beneficiaries. For health services and health policy researchers, one barrier to addressing these disparities is the ability to use Medicare data to ascertain information about an individual's income level or poverty, beca...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000606
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:In 2002 British Columbia, Canada began redistributing its hospital services. OBJECTIVE AND DESIGN:We used administrative data and interrupted time series analyses to determine how recent hospital closures affected patient outcomes. SUBJECTS:All adult acute myocardial infarction (AMI), stroke, and trauma ev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000619
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. METHODS:The patients' characteristics in an urban ED were collect...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200502000-00010
更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:Understanding barriers to health care access experienced by people with disabilities who are members of underserved racial/ethnic groups is key to developing interventions to improve access. OBJECTIVE:To conduct a scoping review of the literature to examine the published literature on barriers to health car...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0000000000000195
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Emergency Department (ED) boarding threatens patient safety. It is unclear whether boarding differentially affects patients admitted to intensive care units (ICUs) versus non-ICU settings. RESEARCH DESIGN AND SUBJECTS:We performed a 2-hospital, 18-month, cross-sectional, observational, descriptive study of ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000902
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by syst...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001158
更新日期:2019-10-01 00:00:00
abstract::This study was undertaken to determine if a measure of severity of illness for psychiatric patients, the Psychiatric Severity of Illness Index, could produce psychiatric case mix groups that are more homogeneous with respect to resource use than the diagnosis-related groups (DRGs). Psychiatric Severity of Illness data...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198901000-00007
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Federal regulation requires hospitals to present patients with a Notice of Privacy Practices (NPP) that contains all stipulated content items, is readable by patients, and posted on institutional web sites. OBJECTIVE:The objective of this study was to determine whether the NPP texts contain the required con...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000163646.90393.e4
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:The association between volume of patients treated and quality of care has important implications for patient referral policies and approaches to quality improvement. Most studies have focused on hospital volume alone and health outcomes. OBJECTIVES:The objective of this work was to examine the association ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200011000-00004
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:In the setting of declining U.S. literacy, new policies include use of clear communication and low-literacy accessibility practices with all patients. Reliable methods for adapting health information to meet such criteria remain a pressing need. OBJECTIVES:To report method validation (study 1) and method re...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318249d6c8
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:Medicare and private plans are encouraging individuals to seek care at hospitals that are designated as centers of excellence. Few evaluations of such programs have been conducted. This study examines a large national initiative that designated hospitals as centers of excellence for knee and hip replacement....
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182699407
更新日期:2013-01-01 00:00:00