Rapoport J, Teres D, Lemeshow S, Gehlbach S
Department of Economics, Mount Holyoke College, South Hadley, MA 01075.
Crit Care Med. 1994 Sep;22(9):1385-91. doi: 10.1097/00003246-199409000-00006.
To present an approach for assessing intensive care unit (ICU) performance which takes into account both economic and clinical performance while adjusting for severity of illness. To present a graphic display which permits comparisons among a group of hospitals.
A multicenter, inception cohort study.
Twenty-five ICUs in U.S. hospitals that participated in the European and North American Study of Severity Systems for ICU Patients.
Consecutive patients (n = 3,397) admitted to ICUs in participating hospitals between September 30, 1991 and December 27, 1991. Excluded were coronary care patients, burn patients, cardiac surgery patients and patients aged < 18 yrs.
The clinical performance index is the difference between observed hospital survival rate and survival rate predicted by the Mortality Probability Model measuring severity of illness at ICU admission. The economic performance (resource use) measure is a length of stay index, Weighted Hospital Days, which weights ICU days more heavily than non-ICU days. The economic performance index is the difference between actual mean resource use and the resource use predicted by a regression including severity of illness and percent of surgical patients. Both the clinical and economic performance indices are standardized to show how far a particular hospital is from the overall mean and are graphed together. Most of the 25 hospitals lie within 1 SD of the mean on both clinical and economic performance scales. The graph makes it easy to identify those hospitals that are outside this range. There is no evidence of a trade-off between high clinical performance and high economic performance; i.e., it is possible to achieve both.
Cross-indexing of clinical and economic ICU performance is easy to calculate. It has potential as a research and evaluation tool used by physicians, hospital administrators, payers, and others.
提出一种评估重症监护病房（ICU）绩效的方法，该方法在调整疾病严重程度的同时兼顾经济和临床绩效。提供一种图形展示方式，以便在一组医院之间进行比较。
一项多中心、起始队列研究。
美国医院的25个ICU，这些医院参与了欧洲和北美ICU患者严重程度系统研究。
1991年9月30日至1991年12月27日期间入住参与研究医院ICU的连续患者（n = 3397）。排除冠心病监护患者、烧伤患者、心脏手术患者以及年龄<18岁的患者。
临床绩效指数是观察到的医院生存率与通过死亡率概率模型预测的生存率之间的差值，该模型用于测量ICU入院时的疾病严重程度。经济绩效（资源利用）指标是住院时间指数，即加权医院日，相较于非ICU日，对ICU日给予更大权重。经济绩效指数是实际平均资源利用与通过包含疾病严重程度和手术患者百分比的回归预测的资源利用之间的差值。临床和经济绩效指数均进行了标准化处理，以显示特定医院与总体均值的差距，并绘制在一起。25家医院中的大多数在临床和经济绩效量表上均处于均值的1个标准差范围内。该图形便于识别超出此范围的医院。没有证据表明高临床绩效和高经济绩效之间存在权衡；即有可能同时实现两者。
ICU临床和经济绩效的交叉索引易于计算。它有潜力作为医生、医院管理人员、付款方及其他人员使用的研究和评估工具。
