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Variations in Case-Mix–Adjusted Duration of Mechanical Ventilation Among ICUs*
Kramer, Andrew A. PhD; Gershengorn, Hayley B. MD; Wunsch, Hannah MD, MSc; Zimmerman, Jack E. MD, FCCM, Critical Care Medicine, June 2016


The author's objectives were to develop a model that predicts the duration of mechanical ventilation and then to use this model to
compare observed versus expected duration of mechanical ventilation across ICUs. The setting included eighty-six eligible ICUs at 48 U.S. hospitals,

with ICU patients receiving mechanical ventilation on day 1 (n = 56,336) admitted from January 2013 to September 2014.

Measurements and Main Results: We developed and validated a multivariable logistic regression model for predicting duration of mechanical ventilation using ICU

day 1 patient characteristics. Mean observed minus expected duration of mechanical ventilation was then obtained across patients and for each ICU. The accuracy of the model was assessed using R2. We defined better performing units as ICUs that had an observed minus expected duration of mechanical ventilation less than –0.5 days and a p value of less than 0.01; and poorer performing units as ICUs with an observed  minus expected duration of mechanical ventilation greater than +0.5 days and a p value of less than 0.01.  For the rest of the study, click here to receive a copy.


ACUITY 2016 Severity Scoring System


The new ACUITY 2016 system is more accurate than APACHE IV and provides a a better snapshot of an ICU’s adjusted mortality, LOS, and duration of mechanical ventilation. For more, Click here.

MDN PHOENIX Critical Care Software


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The Revealing Signs of Outdated ICU Predictive Models | Watch

Dr. Andrew Kramer of Prescient Healthcare Consulting

( explains why the Case Mix Index

(CMI) and APACHE IV are substandard models for evaluating today's ICUs along with introducing his latest and greatest predictive models, ACUITY 2016.

What is a Standardized Mortality Ratio (SMR)?  | Watch

Dr. Andrew Kramer of Prescient Healthcare Consulting

( speaks at the SCCM Conference

in Orlando, Florida on his new model, ACUITY 2016,

and the value of severity adjusted modeling and standardized

mortality ratios (SMR) in evaluating ICUs.

GlucoStabilizer® Insulin Dosing System


FDA cleared GlucoStabilizer reduces hypoglycemia by automating the calculation and insulin dose for IV infusions.  It also automatically adjusts the insulin dose, timing of next glucose test and the target range. To visit the GlucoStabilizer website, Click here.

ICUTracker®  ICU Database


ICUTracker features easy to use, menu-drive software that helps show you the state of your critical care units and provides information and reports that can lead to improved outcomes and quality. 

To visit the ICUTracker website, Click here.

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