Volume-Outcome Relationships in Pediatric Intensive Care Units
Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volum...
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| Veröffentlicht in: | Pediatrics (Evanston) 2000-08, Vol.106 (2), p.289-294 |
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| creator | Tilford, John M Simpson, Pippa M Green, Jerril W Lensing, Shelly Fiser, Debra H |
| description | Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care.
This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay.
A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group. Participants. Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993.
Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences.
The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio:.95; 95% confidence interval:.91-.99), and reduced length of stay (incident rate ratio:.98; 95% confidence interval:.975-.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay.
The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children. |
| doi_str_mv | 10.1542/peds.106.2.289 |
| format | Article |
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This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay.
A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group. Participants. Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993.
Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences.
The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio:.95; 95% confidence interval:.91-.99), and reduced length of stay (incident rate ratio:.98; 95% confidence interval:.975-.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay.
The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.106.2.289</identifier><identifier>PMID: 10920153</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: Am Acad Pediatrics</publisher><subject><![CDATA[Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Cohort Studies ; Critical care ; Diagnosis-Related Groups - statistics & numerical data ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Female ; Hospital Bed Capacity - statistics & numerical data ; Hospital Mortality ; Hospital Planning - statistics & numerical data ; Hospital stays ; Hospital utilization ; Hospitals ; Humans ; Infant ; Infant mortality ; Infants ; Infants (Newborn) ; Intensive care medicine ; Intensive care units ; Intensive Care Units, Pediatric - statistics & numerical data ; Length of stay ; Length of Stay - statistics & numerical data ; Male ; Management ; Medical sciences ; Mortality ; Newborn infants ; Patient outcomes ; Pediatrics ; Prospective Studies ; Quality of Health Care - statistics & numerical data ; Referral and Consultation - statistics & numerical data ; Severity of Illness Index ; United States]]></subject><ispartof>Pediatrics (Evanston), 2000-08, Vol.106 (2), p.289-294</ispartof><rights>2000 INIST-CNRS</rights><rights>COPYRIGHT 2000 American Academy of Pediatrics</rights><rights>COPYRIGHT 2000 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Aug 2000</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c597t-1f009f654f86948d74fe30b7aa0267c72ac92d6fab5bb64b2ae620d0242f34b93</citedby><cites>FETCH-LOGICAL-c597t-1f009f654f86948d74fe30b7aa0267c72ac92d6fab5bb64b2ae620d0242f34b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1477934$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10920153$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tilford, John M</creatorcontrib><creatorcontrib>Simpson, Pippa M</creatorcontrib><creatorcontrib>Green, Jerril W</creatorcontrib><creatorcontrib>Lensing, Shelly</creatorcontrib><creatorcontrib>Fiser, Debra H</creatorcontrib><title>Volume-Outcome Relationships in Pediatric Intensive Care Units</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care.
This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay.
A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group. Participants. Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993.
Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences.
The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio:.95; 95% confidence interval:.91-.99), and reduced length of stay (incident rate ratio:.98; 95% confidence interval:.975-.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay.
The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Critical care</subject><subject>Diagnosis-Related Groups - statistics & numerical data</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Female</subject><subject>Hospital Bed Capacity - statistics & numerical data</subject><subject>Hospital Mortality</subject><subject>Hospital Planning - statistics & numerical data</subject><subject>Hospital stays</subject><subject>Hospital utilization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant mortality</subject><subject>Infants</subject><subject>Infants (Newborn)</subject><subject>Intensive care medicine</subject><subject>Intensive care units</subject><subject>Intensive Care Units, Pediatric - statistics & numerical data</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Management</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Newborn infants</subject><subject>Patient outcomes</subject><subject>Pediatrics</subject><subject>Prospective Studies</subject><subject>Quality of Health Care - statistics & numerical data</subject><subject>Referral and Consultation - statistics & numerical data</subject><subject>Severity of Illness Index</subject><subject>United States</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0s2L1DAYB-AiijuuXj1KEREP25qkSdNehGXQdWFgRFyvIU3fzGRJ09kk9eO_N0MHZkeGHPLBk7zh5ZdlrzEqMaPk4w76UGJUl6QkTfskW2DUNgUlnD3NFghVuKAIsYvsRQj3CCHKOHmeXSREEGbVIvv0c7TTAMV6imocIP8OVkYzurA1u5Abl3-D3sjojcpvXQQXzC_Il9JDfudMDC-zZ1raAK8O82V29-Xzj-XXYrW-uV1erwrFWh4LrBFqdc2obuqWNj2nGirUcSkRqbniRKqW9LWWHeu6mnZEQk1QjwgluqJdW11m7-d3d358mCBEMZigwFrpYJyC4JiwmiGa4Nv_4P04eZf-JghpKoZxWyV0NaONtCCM02P0Um3AgZd2dKBNOr7mmKKKNizx4gxPo4fBqHP-w4lPJMKfuJFTCKK5WZ3Qq3NUjdbCBkTq4XJ9wsuZKz-G4EGLnTeD9H8FRmKfB7HPQ9rUgoiUh3ThzaEdUzdA_4jPAUjg3QHIoKTVXjplwtFRztuKHgtvzWb723jYF5pzER4tj4X_Ae4Kyoc</recordid><startdate>20000801</startdate><enddate>20000801</enddate><creator>Tilford, John M</creator><creator>Simpson, Pippa M</creator><creator>Green, Jerril W</creator><creator>Lensing, Shelly</creator><creator>Fiser, Debra H</creator><general>Am Acad Pediatrics</general><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20000801</creationdate><title>Volume-Outcome Relationships in Pediatric Intensive Care Units</title><author>Tilford, John M ; Simpson, Pippa M ; Green, Jerril W ; Lensing, Shelly ; Fiser, Debra H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c597t-1f009f654f86948d74fe30b7aa0267c72ac92d6fab5bb64b2ae620d0242f34b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Critical care</topic><topic>Diagnosis-Related Groups - statistics & numerical data</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Female</topic><topic>Hospital Bed Capacity - statistics & numerical data</topic><topic>Hospital Mortality</topic><topic>Hospital Planning - statistics & numerical data</topic><topic>Hospital stays</topic><topic>Hospital utilization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant mortality</topic><topic>Infants</topic><topic>Infants (Newborn)</topic><topic>Intensive care medicine</topic><topic>Intensive care units</topic><topic>Intensive Care Units, Pediatric - statistics & numerical data</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Management</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Newborn infants</topic><topic>Patient outcomes</topic><topic>Pediatrics</topic><topic>Prospective Studies</topic><topic>Quality of Health Care - statistics & numerical data</topic><topic>Referral and Consultation - statistics & numerical data</topic><topic>Severity of Illness Index</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tilford, John M</creatorcontrib><creatorcontrib>Simpson, Pippa M</creatorcontrib><creatorcontrib>Green, Jerril W</creatorcontrib><creatorcontrib>Lensing, Shelly</creatorcontrib><creatorcontrib>Fiser, Debra H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tilford, John M</au><au>Simpson, Pippa M</au><au>Green, Jerril W</au><au>Lensing, Shelly</au><au>Fiser, Debra H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Volume-Outcome Relationships in Pediatric Intensive Care Units</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2000-08-01</date><risdate>2000</risdate><volume>106</volume><issue>2</issue><spage>289</spage><epage>294</epage><pages>289-294</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care.
This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay.
A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group. Participants. Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993.
Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences.
The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio:.95; 95% confidence interval:.91-.99), and reduced length of stay (incident rate ratio:.98; 95% confidence interval:.975-.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay.
The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>10920153</pmid><doi>10.1542/peds.106.2.289</doi><tpages>6</tpages></addata></record> |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Child Child, Preschool Cohort Studies Critical care Diagnosis-Related Groups - statistics & numerical data Emergency and intensive care: neonates and children. Prematurity. Sudden death Female Hospital Bed Capacity - statistics & numerical data Hospital Mortality Hospital Planning - statistics & numerical data Hospital stays Hospital utilization Hospitals Humans Infant Infant mortality Infants Infants (Newborn) Intensive care medicine Intensive care units Intensive Care Units, Pediatric - statistics & numerical data Length of stay Length of Stay - statistics & numerical data Male Management Medical sciences Mortality Newborn infants Patient outcomes Pediatrics Prospective Studies Quality of Health Care - statistics & numerical data Referral and Consultation - statistics & numerical data Severity of Illness Index United States |
| title | Volume-Outcome Relationships in Pediatric Intensive Care Units |
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