Ohbe Hiroyuki, Sasabuchi Yusuke, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Data Science Center, Jichi Medical University, Shimotsuke, Japan.
JMA J. 2021 Oct 15;4(4):397-404. doi: 10.31662/jmaj.2021-0098. Epub 2021 Sep 27.
In this present study, we aimed to assess whether care in resource-rich intensive care unit (ICU) was associated with lower ICU mortality compared with care in standard ICU.
This retrospective cohort study used administrative data that are routinely collected in Japan. Using the Japanese Diagnosis Procedure Combination inpatient database, we identified patients aged >15 years who were admitted to the ICU from April 2016 to March 2019. We defined resource-rich ICUs as ICUs with two or more intensivists as full-time employees, ≥20 m per ICU bed, and a medical engineer in the hospital 24 hours per day; other ICUs were categorized as standard ICUs. The primary outcome was ICU mortality. A generalized estimating equation approach with ICUs as the clusters was used to compare ICU mortality between the two groups.
Of the 789,630 eligible patients from 458 ICUs, 237,138 (30%) were treated in the 111 resource-rich ICUs, whereas 552,492 (70%) were treated in the 347 standard ICUs. The crude ICU mortality rate was 3.6% (8443/237,138) among patients admitted to resource-rich ICUs, while it was 4.3% (23,490/552,492) among those admitted to standard ICUs. The results of the generalized estimating equation analysis showed that patients treated in resource-rich ICUs tended to have lower ICU mortality compared to patients treated in standard ICUs (difference, -0.4%; 95% confidence interval, -0.8%-0.0%).
The findings of this nationwide study suggest that, compared with care in standard ICUs, care in resource-rich ICUs is associated with lower ICU mortality. This study showed the overall effect of treatment in hospitals with resource-rich ICUs including intensivist staffing and greater hospital resources. Further studies are required to assess the effects of organizational factors on mortality.
在本研究中，我们旨在评估与标准重症监护病房（ICU）的护理相比，资源丰富的ICU护理是否与更低的ICU死亡率相关。
这项回顾性队列研究使用了日本常规收集的行政数据。利用日本诊断程序组合住院患者数据库，我们确定了2016年4月至2019年3月期间入住ICU的15岁以上患者。我们将资源丰富的ICU定义为有两名或更多全职重症医学专家、每张ICU床位面积≥20平方米且医院每天有一名医学工程师的ICU；其他ICU归类为标准ICU。主要结局是ICU死亡率。采用以ICU为聚类的广义估计方程方法比较两组之间的ICU死亡率。
在来自458个ICU的789,630名符合条件的患者中，111个资源丰富的ICU治疗了237,138名（30%）患者，而347个标准ICU治疗了552,492名（70%）患者。入住资源丰富的ICU的患者中，粗ICU死亡率为3.6%（8443/237,138），而入住标准ICU的患者中为4.3%（23,490/552,492）。广义估计方程分析结果显示，与在标准ICU接受治疗的患者相比，在资源丰富的ICU接受治疗的患者ICU死亡率往往更低（差异为-0.4%；95%置信区间为-0.8%至-0.0%）。
这项全国性研究的结果表明，与标准ICU的护理相比，资源丰富的ICU护理与更低的ICU死亡率相关。本研究显示了资源丰富的ICU所在医院的治疗总体效果，包括重症医学专家配备和更多医院资源。需要进一步研究来评估组织因素对死亡率的影响。
