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.
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