Nathanson Brian H, Higgins Thomas L, Teres Daniel, Copes Wayne S, Kramer Andrew, Stark Maureen
OptiStatim LLC, Longmeadow, MA, USA.
Crit Care Med. 2007 Aug;35(8):1853-62. doi: 10.1097/01.CCM.0000275272.57237.53.
In 1994, Rapoport et al. published a two-dimensional graphical tool for benchmarking intensive care units (ICUs) using a Mortality Probability Model (MPM0-II) to assess clinical performance and a Weighted Hospital Days scale (WHD-94) to assess resource utilization. MPM0-II and WHD-94 do not calibrate on contemporary data, giving users of the graph an inflated assessment of their ICU's performance. MPM0-II was recently updated (MPM0-III) but not the model for predicting resource utilization. The objective was to develop a new WHD model and revised Rapoport-Teres graph.
Multicenter cohort study.
One hundred thirty-five ICUs in 98 hospitals participating in Project IMPACT.
Patients were 124,855 MPM0-II eligible Project IMPACT patients treated between March 2001 and June 2004.
None.
WHD was redefined as 4 units for the first day of each ICU stay, 2.5 units for each additional ICU day, and 1 unit for each non-ICU day after the first ICU discharge. Stepwise linear regression was used to construct a model to predict ICU-specific log average WHD from 39 candidate variables available in Project IMPACT. The updated WHD model has four independent variables: percent of patients dying in the hospital, percent of unscheduled surgical patients, percent of patients on mechanical ventilation within 1 hr of ICU admission, and percent discharged from the ICU to an external post-acute care facility. The first three variables increase average WHD and the last decreases it. The new model has good performance (R = 0.47) and, when combined with MPM0-II, provides a well-calibrated Rapoport-Teres graph.
A new WHD model has been derived from a large, contemporary critical care database and, when used with MPM0-III, updates a popular method for benchmarking ICUs. Project IMPACT participants will likely perceive a decline in their ICU performance coordinates due to the recalibrated graph and should instead focus on their unit's performance relative to their peers.
1994年，拉波波特等人发表了一种二维图形工具，用于对重症监护病房（ICU）进行基准评估，该工具使用死亡率概率模型（MPM0-II）评估临床绩效，并使用加权住院天数量表（WHD-94）评估资源利用情况。MPM0-II和WHD-94未根据当代数据进行校准，这使得该图形的使用者对其ICU的绩效评估过高。MPM0-II最近进行了更新（MPM0-III），但预测资源利用情况的模型未更新。目的是开发一种新的WHD模型并修订拉波波特-特雷斯图。
多中心队列研究。
98家参与“影响计划”的医院中的135个ICU。
患者为2001年3月至2004年6月期间接受治疗的124855例符合MPM0-II标准的“影响计划”患者。
无。
WHD被重新定义为每次入住ICU的第一天为4个单位，入住ICU后的每一天额外增加2.5个单位，首次从ICU出院后的每个非ICU日为1个单位。使用逐步线性回归构建一个模型，以根据“影响计划”中可用的39个候选变量预测特定ICU的对数平均WHD。更新后的WHD模型有四个自变量：院内死亡患者百分比、非计划手术患者百分比、入住ICU后1小时内接受机械通气的患者百分比以及从ICU转至外部急性后期护理机构的出院患者百分比。前三个变量会增加平均WHD，最后一个变量会降低平均WHD。新模型具有良好的性能（R = 0.47），并且与MPM0-II结合使用时，可提供校准良好的拉波波特-特雷斯图。
已从一个大型当代重症监护数据库中得出一个新的WHD模型，该模型与MPM0-III一起使用时，更新了一种常用的ICU基准评估方法。由于重新校准了图表，“影响计划”的参与者可能会觉得其ICU的绩效坐标有所下降，而应转而关注其科室相对于同行的绩效。
