Top

Published in:

01-08-2020 | Chronic Obstructive Lung Disease | COPD

A Cross-sectional Study of Hospital Performance on ICU Utilization Practices for Patients with Chronic Obstructive Pulmonary Disease

Authors: Kusum S. Mathews, Neha N. Goel, Carmen Vargas-Torres, Ashley D. Olson, Jing Zhou, Charles A. Powell, Madhu Mazumdar, Gregory N. Stock, Christopher M. McDermott

Published in: Lung | Issue 4/2020

Abstract

Purpose

Intensive care unit (ICU) resources are a costly but effective commodity used in the management of critically ill patients with chronic obstructive pulmonary disease (COPD). ICU admission decisions are determined by patient diagnosis and severity of illness, but also may be affected by hospital differences in quality and performance. We investigate the variability in ICU utilization for patients with COPD and its association with hospital characteristics.

Methods

Using a 3M administrative dataset spanning 2008–2013, we conducted a retrospective cohort study of adult patients discharged with COPD at hospitals in three state to determine variability in ICU utilization. Quality metrics were calculated for each hospital using observed-to-expected (O/E) ratios for overall mortality and length of stay. Logistic and multilevel multivariate regression models were constructed, estimating the association between hospital quality metrics on ICU utilization, after adjustment for available clinical factors and hospital characteristics.

Results

In 434 hospitals with 570,517 COPD patient visits, overall ICU admission rate was 33.1% [range 0–89%; median (IQR) 24% (8, 54)]. The addition of patient, hospital, and quality characteristics decreased the overall variability attributable to individual hospital differences seen within our cohort from 40.9 to 33%. Odds of ICU utilization were increased for larger hospitals and those seeing lower pulmonary case volume. Hospitals with better overall O/E ratios for length of stay or mortality had lower ICU utilization.

Conclusions

Hospital characteristics, including quality metrics, are associated with variability in ICU utilization for COPD patients, with higher ICU utilization seen for lower performing hospitals.

Available only for authorised users

Wang Q, Bourbeau J (2005) Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD. Respirology 10(3):334–340CrossRef

Molinari N, Briand C, Vachier I, Malafaye N, Aubas P, Georgescu V, Roche N, Chanez P, Bourdin A (2015) Hospitalizations for COPD exacerbations: trends and determinants of death. COPD 12(6):621–627. https://doi.org/10.3109/15412555.2015.1007931 CrossRefPubMed

Funk G-C, Bauer P, Burghuber OC, Fazekas A, Hartl S, Hochrieser H, Schmutz R, Metnitz P (2013) Prevalence and prognosis of COPD in critically ill patients between 1998 and 2008. Eur Respir J 41(4):792–799. https://doi.org/10.1183/09031936.00226411 CrossRefPubMed

Sjoding MW, Prescott HC, Wunsch H, Iwashyna TJ, Cooke CR (2015) Hospitals with the highest intensive care utilization provide lower quality pneumonia care to the elderly. Crit Care Med 43(6):1178–1186. https://doi.org/10.1097/CCM.0000000000000925 CrossRefPubMedPubMedCentral

Wildman MJ, O'Dea J, Kostopoulou O, Tindall M, Walia S, Khan Z (2003) Variation in intubation decisions for patients with chronic obstructive pulmonary disease in one critical care network. QJM 96(8):583–591CrossRef

Valley TS, Admon AJ, Zahuranec DB, Garland A, Fagerlin A, Iwashyna TJ (2019) Estimating ICU benefit: a randomized study of physicians. Crit Care Med 47(1):62–68. https://doi.org/10.1097/CCM.0000000000003473 CrossRefPubMedPubMedCentral

Dres M, Tran TC, Aegerter P, Rabbat A, Guidet B, Huchon G, Roche N, Group C-R (2013) Influence of ICU case-volume on the management and hospital outcomes of acute exacerbations of chronic obstructive pulmonary disease*. Crit Care Med 41(8):1884–1892. https://doi.org/10.1097/CCM.0b013e31828a2bd8 CrossRefPubMed

Celli BR, MacNee W, Agusti A, Anzueto A, Berg B, Buist AS, Calverley PMA, Chavannes N, Dillard T, Fahy B, Fein A, Heffner J, Lareau S, Meek P, Martinez F, McNicholas W, Muris J, Austegard E, Pauwels R, Rennard S, Rossi A, Siafakas N, Tiep B, Vestbo J, Wouters E, ZuWallack R (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 23(6):932–946CrossRef

Seymour CW, Iwashyna TJ, Ehlenbach WJ, Wunsch H, Cooke CR (2012) Hospital-level variation in the use of intensive care. Health Serv Res 47(5):2060–2080. https://doi.org/10.1111/j.1475-6773.2012.01402.x CrossRefPubMedPubMedCentral

10.

Block BM, Sirio CA, Cooper GS, DiGiuseppe DL, Rosenthal GE (2000) Use of intensive care-specific interventions in major teaching and other hospitals: a regional comparison. Crit Care Med 28(4):1204–1207CrossRef

11.

Sasabuchi Y, Yasunaga H, Matsui H, Lefor AK, Horiguchi H, Fushimi K, Sanui M (2015) The volume-outcome relationship in critically ill patients in relation to the ICU-to-hospital bed ratio. Crit Care Med 43(6):1239–1245. https://doi.org/10.1097/CCM.0000000000000943 CrossRefPubMed

12.

Prin M, Wunsch H (2012) International comparisons of intensive care: informing outcomes and improving standards. Curr Opin Crit Care 18(6):700–706. https://doi.org/10.1097/MCC.0b013e32835914d5 CrossRefPubMedPubMedCentral

13.

Nguyen YL, Kahn JM, Angus DC (2010) Reorganizing adult critical care delivery: the role of regionalization, telemedicine, and community outreach. Am J Respir Crit Care Med 181(11):1164–1169. https://doi.org/10.1164/rccm.200909-1441CP CrossRefPubMed

14.

McDermott C, Stock GN (2007) Hospital operations and length of stay performance. Int J Oper Prod Manage 27(9):1020–1042CrossRef

15.

Theokary C, Justin Ren Z (2011) An empirical study of the relations between hospital volume, teaching status, and service quality. Prod Oper Manage 20(3):303–318. https://doi.org/10.1111/j.1937-5956.2011.01228.x CrossRef

16.

Rinne ST, Castaneda J, Lindenauer PK, Cleary PD, Paz HL, Gomez JL (2017) Chronic obstructive pulmonary disease readmissions and other measures of hospital quality. Am J Respir Crit Care Med 196(1):47–55. https://doi.org/10.1164/rccm.201609-1944OC CrossRefPubMedPubMedCentral

17.

Eriksson CO, Stoner RC, Eden KB, Newgard CD, Guise JM (2017) The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review. J Gen Intern Med 32(6):686–696. https://doi.org/10.1007/s11606-016-3936-3 CrossRefPubMed

18.

Statewide Planning and Reserach Cooperative System (SPARCS) (2016) NYS Department of Health Office of Quality and Patient Safety, Bureau of Health Informatics. https://www.health.ny.gov/statistics/sparcs/

19.

Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ (2000) Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet 356(9225):185–189. https://doi.org/10.1016/s0140-6736(00)02478-8 CrossRefPubMed

20.

3M Health Information Systems (2016) https://solutions.3m.com/wps/portal/3M/en_US/Health-Information-Systems/HIS/. Accessed 14 Sept 2016

21.

Averill RF, Goldfield N, Hughes JS, Bonazelli J, McCulloch EC, Mullin R, Tang AM (2008) 3M(TM) APR DRG Classification system: methodology overview. 3M Health Information Systems, Wallingford, CT

22.

Healthcare Cost Report Information System (HCRIS) Centers for medicare & medicaid services. https://www.cms.gov/research-statistics-data-and-systems/downloadable-public-use-files/cost-reports/. Accessed 14 Sept 2016

23.

Lindenauer PK, Lagu T, Ross JS, Pekow PS, Shatz A, Hannon N, Rothberg MB, Benjamin EM (2014) Attitudes of hospital leaders toward publicly reported measures of health care quality. JAMA Intern Med 174(12):1904–1911. https://doi.org/10.1001/jamainternmed.2014.5161 CrossRefPubMedPubMedCentral

24.

McCrum ML, Joynt KE, Orav EJ, Gawande AA, Jha AK (2013) Mortality for publicly reported conditions and overall hospital mortality rates. JAMA Intern Med 173(14):1351–1357. https://doi.org/10.1001/jamainternmed.2013.7049 CrossRefPubMed

25.

McDermott CM, Stock GN (2011) Focus as emphasis: conceptual and performance implications for hospitals. J Oper Manage 29(6):616–626CrossRef

26.

Galvan-Turner VB, Chang J, Ziogas A, Bristow RE (2015) Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for ovarian cancer. Gynecol Oncol 139(3):495–499. https://doi.org/10.1016/j.ygyno.2015.09.015 CrossRefPubMedPubMedCentral

27.

Singh S, Lin YL, Kuo YF, Nattinger AB, Goodwin JS (2014) Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics. J Gen Intern Med 29(4):572–578. https://doi.org/10.1007/s11606-013-2723-7 CrossRefPubMed

28.

Killip S, Mahfoud Z, Pearce K (2004) What is an intracluster correlation coefficient? Crucial concepts for primary care researchers. Ann Fam Med 2(3):204–208CrossRef

29.

Merlo J, Yang M, Chaix B, Lynch J, Rastam L (2005) A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people. J Epidemiol Community Health 59(9):729–736. https://doi.org/10.1136/jech.2004.023929 CrossRefPubMedPubMedCentral

30.

Harrell F (2015) Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. Springer, New YorkCrossRef

31.

Durrleman S, Simon R (1989) Flexible regression models with cubic splines. Stat Med 8(5):551–561CrossRef

32.

Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine (1999) Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 27(3):633–638CrossRef

33.

Walter KL, Siegler M, Hall JB (2008) How decisions are made to admit patients to medical intensive care units (MICUs): a survey of MICU directors at academic medical centers across the United States. Crit Care Med 36(2):414–420. https://doi.org/10.1097/01.CCM.0000299738.26888.37 CrossRefPubMed

34.

Litvak E (ed) (2010) Managing patient flow in hospitals: strategies and solutions, 2nd edn. Joint Commission Resources, Oakbrook Terrace, IL

35.

Barnato AE, Kahn JM, Rubenfeld GD, McCauley K, Fontaine D, Frassica JJ, Hubmayr R, Jacobi J, Brower RG, Chalfin D, Sibbald W, Asch DA, Kelley M, Angus DC (2007) Prioritizing the organization and management of intensive care services in the United States: the PrOMIS conference. Crit Care Med 35(4):1003–1011. https://doi.org/10.1097/01.CCM.0000259535.06205.B4 CrossRefPubMed

36.

Admon AJ, Seymour CW, Gershengorn HB, Wunsch H, Cooke CR (2014) Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism. Chest 146(6):1452–1461. https://doi.org/10.1378/chest.14-0059 CrossRefPubMedPubMedCentral

37.

Gershengorn HB, Iwashyna TJ, Cooke CR, Scales DC, Kahn JM, Wunsch H (2012) Variation in use of intensive care for adults with diabetic ketoacidosis*. Crit Care Med 40(7):2009–2015. https://doi.org/10.1097/CCM.0b013e31824e9eae CrossRefPubMedPubMedCentral

38.

Ko FW, Cheung NK, Rainer TH, Lum C, Wong I, Hui DS (2016) Comprehensive care programme for patients with chronic obstructive pulmonary disease: a randomised controlled trial. Thorax. https://doi.org/10.1136/thoraxjnl-2016-208396 CrossRefPubMedPubMedCentral

39.

Shah T, Press VG, Huisingh-Scheetz M, White SR (2016) COPD readmissions: addressing COPD in the era of value-based healthcare. Chest. https://doi.org/10.1016/j.chest.2016.05.002 CrossRefPubMedPubMedCentral

40.

Lindenauer PK, Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Hill NS (2015) Hospital patterns of mechanical ventilation for patients with exacerbations of COPD. Ann Am Thorac Soc 12(3):402–409. https://doi.org/10.1513/AnnalsATS.201407-293OC CrossRefPubMedPubMedCentral

41.

Stefan MS, Shieh MS, Pekow PS, Hill N, Rothberg MB, Lindenauer PK (2015) Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011. Chest 147(4):959–968. https://doi.org/10.1378/chest.14-1216 CrossRefPubMed

42.

Masa JF, Utrabo I, Gomez de Terreros J, Aburto M, Esteban C, Prats E, Nunez B, Ortega-Gonzalez A, Jara-Palomares L, Martin-Vicente MJ, Farrero E, Binimelis A, Sala E, Serrano-Rebollo JC, Barrot E, Sanchez-Oro-Gomez R, Fernandez-Alvarez R, Rodriguez-Jerez F, Sayas J, Benavides P, Catala R, Rivas FJ, Egea CJ, Anton A, Penacoba P, Santiago-Recuerda A, Gomez-Mendieta MA, Mendez L, Cebrian JJ, Pina JA, Zamora E, Segrelles G (2016) Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units: precision medicine in intermediate care units. BMC Pulm Med 16(1):97. https://doi.org/10.1186/s12890-016-0262-9 CrossRefPubMedPubMedCentral

43.

Vaudan S, Ratano D, Beuret P, Hauptmann J, Contal O, Garin N (2015) Impact of a dedicated noninvasive ventilation team on intubation and mortality rates in severe COPD exacerbations. Respir Care 60(10):1404–1408. https://doi.org/10.4187/respcare.03844 CrossRefPubMed

44.

Stolker JM, Badawi O, Spertus JA, Nasir A, Kennedy KF, Harris IH, Franey CS, Hsu VD, Ripple GR, Howell GH, Lem VM, Chan PS (2015) Intensive care units with low versus high volume of myocardial infarction: clinical outcomes, resource utilization, and quality metrics. J Am Heart Assoc 4(6):e001225. https://doi.org/10.1161/jaha.114.001225 CrossRefPubMedPubMedCentral

45.

Valley TS, Sjoding MW, Goldberger ZD, Cooke CR (2016) Intensive care use and quality of care for patients with myocardial infarction and heart failure. Chest. https://doi.org/10.1016/j.chest.2016.05.034 CrossRefPubMedPubMedCentral

Title: A Cross-sectional Study of Hospital Performance on ICU Utilization Practices for Patients with Chronic Obstructive Pulmonary Disease
Authors: Kusum S. Mathews
Neha N. Goel
Carmen Vargas-Torres
Ashley D. Olson
Jing Zhou
Charles A. Powell
Madhu Mazumdar
Gregory N. Stock
Christopher M. McDermott
Publication date: 01-08-2020
Publisher: Springer US
Keyword: Chronic Obstructive Lung Disease
Published in: Lung / Issue 4/2020
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI: https://doi.org/10.1007/s00408-020-00364-z

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A Cross-sectional Study of Hospital Performance on ICU Utilization Practices for Patients with Chronic Obstructive Pulmonary Disease

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2020

Pulmonary Arteriovenous Malformations in Non-hereditary Hemorrhagic Telangiectasia Patients: An 18-Year Retrospective Study

Pulmonary Embolism in Acute Asthma Exacerbation: Clinical Characteristics, Prediction Model and Hospital Outcomes

Determining Static Hyperinflation in Patients with Severe Emphysema: Relation Between Lung Function Parameters and Patient-Related Outcomes

Increased Th17 and Th22 Cell Percentages Predict Acute Lung Injury in Patients with Sepsis

P2X3-Receptor Antagonists as Potential Antitussives: Summary of Current Clinical Trials in Chronic Cough

Chronic Hepatitis C Virus Infection is Associated with an Increased Risk of Lung Cancer: A Systematic Review and Meta-analysis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page