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Physician-attributable Differences in Intensive Care Unit Costs

A Single-Center Study

Division of Pulmonary and Critical Care Medicine, Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, Ohio

Correspondence and requests for reprints should be addressed to Allan Garland, M.D., M.A., Division of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109. E-mail: agarland{at}metrohealth.org

Rationale: Variation in practice and outcomes, not explained by patient or illness characteristics, is common in health care, including in intensive care units (ICUs).

Objective: To quantify within-ICU, between-physician variation in resource use in a single medical ICU.

Methods: This was a prospective, noninterventional study in a medical ICU where nine intensivists provide care in 14-d rotations. Consecutive sample consisted of 1,184 initial patient admissions whose care was provided by a single intensivist. Multivariate models were constructed for average daily discretionary costs, ICU length of stay, and hospital mortality, adjusting for patient and illness characteristics, and workload.

Measurements and Main Results: The identity of the intensivist was a significant predictor for average daily discretionary costs (p < 0.0001), but not ICU length of stay (p = 0.33) or hospital mortality (p = 0.83). The intensivists had more influence on costs than all other variables except the severity and type of acute illness. Average daily discretionary costs varied by 43% across the different intensivists, equating to a mean difference of $1,003 per admission between the highest and lowest terciles of intensivists.

Conclusions: There are large differences among intensivists in the amount of resources they use to manage critically ill patients. Higher resource use was not associated with lower length of stay or mortality.

Key Words: costs and cost analysis • health resources • health services research • intensive care units

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Widespread variation in practice and outcomes is common in health care. However, we are not aware of any published reports that quantitatively address variation in ICU care attributable to individual intensivists. What This Study Adds to the Field We observed large differences among intensivists in the amount of resources they use to manage critically ill patients. It appears possible to reduce cost-inefficient variation by efforts to promote consistency of care across physicians.

 

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