Cerón DUW, Abascal C, Sierra UA

Language: Spanish
References: 11
Page: 126-135
PDF size: 83.12 Kb.

ABSTRACT

Objective: To compare the performance in an Intensive Care Unit in three periods following the Rapoport method.
Design: A prospective comparative study.
Setting: The Intensive Care Unit of a teaching hospital.
Patients: Patients who were admitted in three different periods: 1 (2 years from April 1995), 2 (one year from June 1998), and 3 (whole 2004).
Interventions: None.
Measurements and main results:

period

Entries

included

IRCE*

IRURE*

1

862

599

-0.44

-

2

492

0.45

-0.201

2.59

3

428

338

4.2

2.27

IRCE = standardized clinical performance index; a positive value reflects less mortality than expected.
IRURE = standardized resource use performance index; a positive value reflects less resource utilization than expected.
* The units are the standard deviation of the mean of participant units in the Rapoport´s original study.

Conclusion: In a 9 year period of assistance activity, there is a trend toward a better clinical performance (effectiveness), as the advantage is preserved in terms of utilization of resources in terms of the original Rapoport´s study.

REFERENCES

1. Jacobs P, Nosewerthy TW. National estimates of intensive care utilization and costs: Canada and the United States. Crit Care Med 1990;18:1282.

2. Gyldmark M, Polit C. A review of cost studies of intensive care units: Problems with the cost concept. Crit Care Med 1995;23:964-972.

3. Cerón U, Esponda J, Borbota M, Vázquez JP. Rendimiento clínico y costo-efectividad de tres unidades de terapia intensiva mexicanas incluidas en la base de datos multicéntrica de terapia intensiva. Rev Asoc Mex Med Crit y Ter Int 2000;14:41-49.

4. Rapoport J, Teres D, Lemeshow S, Gehlbach S. A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study. Crit Care Med 1994;22:1385-1391.

5. Cerón U, Sierra A, Martínez R, Vázquez JP. Base de datos para el control de calidad y utilización de recursos en la Unidad de Terapia Intensiva. Rev Mex Med Crit y Ter Int 1996;10:105-201.

6. Lemeshow S, Teres D, Klar J et al. Mortality Probability Models (MPM II) Based on an International Cohort of Intensive Care Unit Patients.

7. Champion H, Sacco W, Copes W. Trauma Scoring. In: Feliciano D, Moore S, Mattox J editors. Trauma. Third edition. Stamford: Appleton & Lange: 1991:53-67.

8. Knaus WA, Draper EA, Wagner DP et al. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-829.

9. American Thoracic Society. Understanding Costs and Cost-Effectiveness in Critical Care. Am J Respir Crit Care Med 2002;165:540-550.

10. Cerón U, Esponda J, Borboya M, Vazquez JP. Valor predictivo de los sistemas de calificación de gravedad: comparación de cuatro modelos en tres unidades de terapia intensiva mexicanas incluidas en la base de datos multicéntrica de terapia intensiva. Rev Asoc Mex Med Crit y Ter Int 2000;14:50-59.

11. Chernow B. The practice of critical care-Describing who we are, evaluating what we do, and computing the cost. Crit Care Med 1993;21:1413-1414.