Published ahead of print on November 15, 2007, doi:10.1164/rccm.200708-1214OC Am. J. Respir. Crit. Care Med., Volume 177, Number 3, February 2008, 285-291 A more recent version of this article appeared on February 1, 2008
Submitted on August 17, 2007 Potential Value of Regionalized Intensive Care for Mechanically Ventilated Medical PatientsJeremy M Kahn1*,1 Division of Pulmonary, Allergy and Critical Care; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA, 2 ZD Associates, Perkasie, PA, USA, 3 Department of Anesthesiology, Columbia Presbyterian Medical Center, New York, NY, USA, 4 Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 5 Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 6 Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA, 7 CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA * To whom correspondence should be addressed. E-mail: jmkahn{at}mail.med.upenn.edu.
Rationale: Regionalization has been proposed as a method to improve outcomes for medical patients receiving mechanical ventilation in the intensive care unit. Objective: To determine the number of patients that would be affected by regionalization and the potential mortality reduction under a regionalized system of care. Methods: We performed a retrospective cohort study with Monte-Carlo simulation using 2001 state discharge data from eight states representing 42 percent of the United States population. Adult medical patients undergoing invasive mechanical ventilation were identified. Patient location and hospital mortality rates were obtained from the discharge data; estimates of the relative risk reduction in hospital mortality for high volume hospitals compared to low volume hospitals were obtained from the published literature and applied to the cohort. Measurements and main results: Of 180,976 adult medical patients who underwent mechanical ventilation at 1170 non-federal hospitals, 83,050 (46%) received mechanical ventilation at 887 (76%) hospitals with low annual volumes (<275 patients/year). Using published risk estimates, approximately 4,720 lives per year (95% range: 2,522 -6,744) could potentially be saved in the eight states by routinely transferring patients from low to high volume hospitals, representing a number needed to treat of 15.7. The median distance that patients would need to travel to reach a high volume hospital was 8.5 miles (interquartile range: 4.0 - 21.2 miles). Conclusions: Regionalization of intensive care could potentially improve survival for patients undergoing mechanical ventilation. Transfer distances are modest for most patients. Key words: mechanical ventilation, triage, transportation of patients, critical care, Monte Carlo method
This article has been cited by other articles:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
