Hospital-level variation in the development of persistent critical illness

Viglianti, E. M., Bagshaw, S. M., Bellomo, R., McPeake, J. , Wang, X. Q., Seelye, S. and Iwashyna, T. J. (2020) Hospital-level variation in the development of persistent critical illness. Intensive Care Medicine, 46, pp. 1567-1575. (doi: 10.1007/s00134-020-06129-9) (PMID:32500182) (PMCID:PMC7444658)

Abstract

Purpose: Patients with persistent critical illness may account for up to half of all intensive care unit (ICU) bed-days. It is unknown if there is hospital variation in the development of persistent critical illness and if hospital performance affects the incidence of persistent critical illness. Methods: This is a retrospective analysis of Veterans admitted to the Veterans Administration (VA) ICUs from 2015 to 2017. Hospital performance was defined by the risk- and reliability-adjusted 30-day mortality. Persistent critical illness was defined as an ICU length of stay of at least 11 days. We used 2-level multilevel logistic regression models to assess variation in risk- and reliability-adjusted probabilities in the development of persistent critical illness. Results: In the analysis of 100 hospitals which encompassed 153,512 hospitalizations, 4.9% (N = 7640/153,512) developed persistent critical illness. There was variation in the development of persistent critical illness despite controlling for patient characteristics (intraclass correlation: 0.067, 95% CI 0.049–0.091). Hospitals with higher risk- and reliability-adjusted 30-day mortality had higher probabilities of developing persistent critical illness (predicted probability: 0.057, 95% CI 0.051–0.063, p < 0.01) compared to those with lower risk- and reliability-adjusted 30-day mortality (predicted probability: 0.046, 95% CI 0.041–0.051, p < 0.01). The median odds ratio was 1.4 (95% CI 1.33–1.49) implying that, for two patients with the same physiology on admission at two different VA hospitals, the patient admitted to the hospital with higher adjusted mortality would have 40% greater odds of developing persistent critical illness. Conclusion: Hospitals with higher risk- and reliability-adjusted 30-day mortality have a higher probability of developing persistent critical illness. Understanding the drivers of this variation may identify modifiable factors contributing to the development of persistent critical illness.

• Item Type: Articles
• Additional Information: This work was supported by Grants NHLBI T32 HL7749-25 (EMV), K12 HL138039 (EMV, TJI). Dr. Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McPeake, Dr Jo
• Authors: Viglianti, E. M., Bagshaw, S. M., Bellomo, R., McPeake, J., Wang, X. Q., Seelye, S., and Iwashyna, T. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Intensive Care Medicine
• Publisher: Springer
• ISSN: 0342-4642
• ISSN (Online): 1432-1238
• Published Online: 04 June 2020
• Copyright Holders: Copyright © 2020 Springer
• First Published: First published in Intensive Care Medicine 46:1567–1575
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher