Rapoport J, Teres D, Barnett R, Jacobs P, Shustack A, Lemeshow S, Norris C, Hamilton S
Department of Economics, Mount Holyoke College, South Hadley, MA 01075, USA.
Crit Care Med. 1995 Aug;23(8):1336-46. doi: 10.1097/00003246-199508000-00006.
To analyze differences in intensive care unit (ICU) utilization between a Canadian province and a U.S. area.
Retrospective data analysis of hospital discharge data and existing data from an international study of severity of illness in ICU patients.
Administrative data for the province of Alberta and the four counties of western Massachusetts for the years 1990 to 1991 were used. Detailed data on consecutive ICU admissions from two Alberta hospitals, one western Massachusetts hospital, and 24 other U.S. hospitals for 3 months in 1991 were used.
ICU use and hospital mortality rates were compared for 50,030 hospital admissions divided into 11 patient groups. ICU days per million population were two to three times as great in western Massachusetts as in Alberta. The primary reason was higher ICU incidence (percent of hospitalized patients treated in the ICU) rather than a difference in hospital admission rate or length of ICU stay. ICU incidence in western Massachusetts was significantly higher in ten of 11 patient groups--for the coronary bypass surgery group, there was no difference. The hospital mortality rate in western Massachusetts was similar to, or higher than, the mortality rate in Alberta. In Alberta, a much higher proportion of ICU patients received mechanical ventilation. For elective surgery patients, the ICU severity of illness was lower in western Massachusetts and in other U.S. hospitals than in Alberta.
Western Massachusetts hospitalized patients are more likely to be treated in an ICU than are similar patients in Alberta. There is no evidence that the greater ICU utilization in western Massachusetts led to a lower hospital mortality rate.
分析加拿大一个省份与美国一个地区在重症监护病房（ICU）使用情况上的差异。
对医院出院数据以及ICU患者疾病严重程度国际研究中的现有数据进行回顾性数据分析。
使用了1990年至1991年艾伯塔省以及马萨诸塞州西部四个县的行政数据。还使用了1991年3个月期间来自艾伯塔省两家医院、马萨诸塞州西部一家医院以及其他24家美国医院的连续ICU入院详细数据。
对50,030例住院患者进行比较，这些患者被分为11个患者组，比较了ICU使用情况和医院死亡率。马萨诸塞州西部每百万人口的ICU使用天数是艾伯塔省的两到三倍。主要原因是ICU发病率较高（在ICU接受治疗的住院患者百分比），而非医院入院率或ICU住院时长存在差异。在11个患者组中的10组里，马萨诸塞州西部的ICU发病率显著更高——冠状动脉搭桥手术组无差异。马萨诸塞州西部的医院死亡率与艾伯塔省相似或更高。在艾伯塔省，接受机械通气的ICU患者比例要高得多。对于择期手术患者，马萨诸塞州西部以及其他美国医院的ICU疾病严重程度低于艾伯塔省。
与艾伯塔省的类似患者相比，马萨诸塞州西部的住院患者更有可能在ICU接受治疗。没有证据表明马萨诸塞州西部更高的ICU使用率能降低医院死亡率。
