Purpose

Intensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure.

Methods

Data of 207,131 patients treated in 2008–2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015–2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015–2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models.

Results

SMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5–5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR.

Conclusion

The wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.

中文翻译：

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重症监护病房严重程度调整后的资源使用和结果的变化

目的

重症监护患者的死亡风险增加，而且他们的护理费用昂贵。我们调查了风险调整死亡率和用于实现幸存者的资源是否随时间变化，以及它们的变化是否与重症监护病房 (ICU) 组织和结构相关的变量相关。

方法

从基准数据库中提取了 2008-2017 年在芬兰、爱沙尼亚和瑞士的 21 个 ICU 接受治疗的 207,131 名患者的数据。使用 ICU 住院时间、每日治疗干预评分系统评分 (TISS) 和购买力平价调整后的直接成本（2015-2017 年；17 个 ICU）来衡量资源使用情况。计算了观察到的与严重性调整后的预期资源使用率（标准化资源使用率；SRUR）的比率。预期幸存者人数和观察到的死亡率与预期死亡率的比率（标准化死亡率；SMR）基于涵盖 2015-2017 年的死亡率预测模型。十四个反映结构和组织的先验变量被用作多变量模型中 SRUR 的解释变量。

结果

SMR 随着时间的推移而降低，而 SRUR 保持不变，除了基于 TISS 的 SRUR 降低。ICU 一天的直接成本、TISS 评分和 ICU 入院率在 ICU 之间相差 2.5-5 倍。各个 ICU 在 SRUR 和 SMR 方面的差异高达 > 3 倍，并且它们的演变变化很大，SRUR 和 SMR 之间没有明确的关联。高患者周转率始终与低 SRUR 有关，但与 SMR 无关。

结论

SMR 和 SRUR 的广泛且独立的变化表明它们应该一起使用来比较不同 ICU 或单个 ICU 随着时间的推移的性能。