The variation in risk adjusted mortality of intensive care units.

BACKGROUND

This study aimed to estimate risk adjusted mortality rate in the ICUs (Intensive care units) by APACHE (Acute Physiology And Chronic Health Evaluation) III for revealing the performance variation in ICUs.

METHODS

This study focused on 1,090 patients in the ICUs of 18 hospitals. For establishing risk adjusted mortality predictive model, logistic regression analysis was performed. APACHE III, surgery experience, admission route, and major disease categories were used as independent variables. The performance of each model was evaluated by c-statistic and goodness-of-fit test of Hosmer-Lemeshow. Using this predictive model, the performance of each ICU was tested as ratio of predictive mortality rate and observed mortality rate.

RESULTS

The average observed mortality rate was 24.1%. The model including APACHE III score, admission route, and major disease categories was signified as the fittest one. After risk adjustment, the ratio of predictive mortality rate and observed mortality rate was distributed from 0.49 to 1.55.

CONCLUSIONS

The variation in risk adjusted mortality among ICUs was wide. The effort to reduce this quality difference is needed.