Pérez Adriana, Dennis Rodolfo J, Rondón Martin A, Metcalfe M Alison, Rowan Kathy M
Clinical Epidemiology and Biostatistics Unit, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.
J Clin Epidemiol. 2006 Jan;59(1):94-101. doi: 10.1016/j.jclinepi.2005.06.004. Epub 2005 Nov 2.
Our main outcome was to identify organizational characteristics that help to evaluate the differences between the intensive care mortality ratios adjusted by APACHE II. We incorporated the variation associated with the ranking of institutions simulating its random effects under a binomial distribution.
A nationwide survey on structure, technology, and staffing resources available in Colombian intensive care units during 1997-1998 was conducted. We collected data on admissions from 20 randomly selected adult medical and surgical intensive care units.
The mortality ratio from the 20 intensive care units ranged from 0.59 to 2.36; 80% of the intensive care units had a mortality ratio greater than 1. All four intensive care units with the lowest mortality ratio belonged to private institutions, while four of five institutions with the highest mortality belonged to the public sector. Intensive care units in private institutions also had fewer number of beds, lower median length of stay, lower occupancy rates, higher education training for specialists and nurses and fewer emergency nonelective surgical procedures.
We successfully accounted for intensive care mortality baseline differences and random effects variations. There were substantial differences between intensive care units in institution type, bed availability, technology, staffing resources, and degree of training, which may have been associated with patient outcome. These results are of crucial importance to track, detect and assess future changes.
我们的主要成果是确定有助于评估经急性生理与慢性健康状况评分系统（APACHE II）调整后的重症监护死亡率差异的组织特征。我们纳入了与机构排名相关的变异，在二项分布下模拟其随机效应。
对1997 - 1998年期间哥伦比亚重症监护病房可用的结构、技术和人员配备资源进行了全国性调查。我们收集了20个随机选择的成人医疗和外科重症监护病房的入院数据。
20个重症监护病房的死亡率范围为0.59至2.36；80%的重症监护病房死亡率大于1。死亡率最低的四个重症监护病房均属于私立机构，而死亡率最高的五个机构中有四个属于公共部门。私立机构的重症监护病房床位数量较少，住院时间中位数较短，占用率较低，专科医生和护士的教育培训水平较高，急诊非择期手术程序较少。
我们成功地解释了重症监护死亡率的基线差异和随机效应变异。不同机构类型的重症监护病房在床位可用性、技术、人员配备资源和培训程度方面存在显著差异，这些差异可能与患者预后相关。这些结果对于跟踪、检测和评估未来变化至关重要。
