Studnicki J, Schapira D V, Straumfjord J V, Clark R A, Marshburn J, Werner D C
Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa 33612.
Cancer. 1994 Oct 15;74(8):2366-73. doi: 10.1002/1097-0142(19941015)74:8<2366::aid-cncr2820740823>3.0.co;2-z.
The broad picture of intensive care unit (ICU) outcomes and expenditures cannot be discerned from previous studies that were conducted at single hospitals and focused on narrow subsets of patients.
This study provides a comprehensive national profile of ICU used by Medicare patients with cancer. The data source was the Medicare Provider Analysis and Review file for fiscal year 1990, representing 100% of all hospital admissions that occurred within 723 ICD-9-CM codes and organized into 11 code groups. Using screening criteria, admissions were categorized as surgical (both major and minor procedures) or nonsurgical (no procedures) and with and without involvement of the ICU. The categories were compared using the following outcome variables: total hospital charges, ICU charges, ancillary charges, average length of stay, and in-hospital mortality.
This study population accounted for nearly 800,000 admissions, of which 143,458 (18.1%) involved the use of the ICU. Actual ICU charges represented 4.9% of the $9.3 billion in total hospital charges. Intensive care unit use is associated positively with service intensity, and 73% of all the admissions involving the ICU were for major procedures. Only 2% involved no procedures. Admissions involving use of the ICU generate higher charges and longer lengths of stay than non-ICU admissions, although the differences decrease with declining treatment intensity and resource use. In-hospital mortality rates, for those cases that used the ICU, were 9.8% for major procedures, 21.2% for minor procedures, and 37.6% for cases involving no procedures.
Contrary to the conclusions drawn from previous research, these findings suggest that patients who receive less intense service and use fewer hospital resources are more likely to die in the hospital than those who receive more care, with or without a stay in the ICU during the hospitalization. A global view of ICU use does not support the conclusion that a disproportionate share of special care resources is expended on futile care of the terminally ill or excessive monitoring of low risk patients, although these problems undoubtedly exist. Analysis of comprehensive national data regarding the use of intensive care provides a perspective that challenges some of the conclusions based on more limited studies that were conducted in single hospitals and focused on nonsurvivors or subsets of patients narrowly defined in other ways.
以往在单一医院开展的、聚焦于狭窄患者亚组的研究，无法洞悉重症监护病房（ICU）的总体结局及费用情况。
本研究提供了一份全面的全国性医保癌症患者使用ICU情况的概述。数据来源是1990财年的医保提供者分析与审查文件，涵盖了723个国际疾病分类第九版临床修订本（ICD - 9 - CM）编码下的所有住院病例，这些病例被组织成11个编码组。根据筛选标准，住院病例被分类为手术类（包括大手术和小手术）或非手术类（无手术），以及是否使用ICU。使用以下结局变量对这些类别进行比较：医院总费用、ICU费用、辅助费用、平均住院时长和院内死亡率。
本研究人群包括近80万例住院病例，其中143458例（18.1%）使用了ICU。实际ICU费用占93亿美元医院总费用的4.9%。ICU的使用与服务强度呈正相关，所有涉及ICU的住院病例中有73%是大手术。只有2%不涉及任何手术。与未使用ICU的住院病例相比，使用ICU的住院病例产生的费用更高，住院时长更长，不过随着治疗强度和资源使用的降低，差异也随之减小。对于使用ICU的病例，大手术的院内死亡率为9.8%，小手术为21.2%，无手术的病例为37.6%。
与以往研究得出的结论相反，这些发现表明，与接受更多护理（无论住院期间是否入住ICU）的患者相比，接受服务强度较低且使用医院资源较少的患者更有可能在医院死亡。对ICU使用情况的整体看法并不支持这样的结论，即特殊护理资源不成比例地用于对绝症患者的无效护理或对低风险患者的过度监测，尽管这些问题无疑是存在的。对全国范围内关于重症监护使用情况的综合数据进行分析，提供了一个视角，对基于在单一医院开展的、更有限的研究（这些研究聚焦于非幸存者或以其他方式狭义定义的患者亚组）得出的一些结论提出了挑战。
