ArticleIntensive care medicine2015
The association between ICU level of care and mortality in the Netherlands.
Article in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- The functional landscape of critical care: a nationwide study of volume, capability, and institutional variation in South Korea.Acute and critical care · 2026Article
- Data Resource Profile Update: The Dutch National Intensive Care Evaluation (NICE) registry.International journal of epidemiology · 2026Article
- Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study.PloS one · 2023Observational
- Relationship between institutional intensive care volume prior to the COVID-19 pandemic and in-hospital death in ventilated patients with severe COVID-19.Scientific reports · 2022Observational
- Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals.Critical care (London, England) · 2020Article
- Intensive care medicine in smaller hospitals: here to stay.Future healthcare journal · 2020Article
- Observational
- Specialist not tertiary: Providing intensive care medicine in a district general hospital.Journal of the Intensive Care Society · 2018Article
- Post-intensive care outpatient clinic: is it feasible and effective? A literature review.Revista Brasileira de terapia intensiva · 2018Review
- [Reimbursement of intensive care services in the German DRG system : Current problems and possible solutions].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2018Article
- Mapping the Characteristics of Critical Care Facilities: Assessment, Distribution, and Level of Critical Care Facilities from Central India.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2017Article
- Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study.BMC health services research · 2017Article
- PICU Volume and Outcome: A Severity-Adjusted Analysis.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Article
- Response to Girbes et al.: Investigating associations between ICU level and quality of care in the Netherlands: reporting only SMRs is not the whole story.Intensive care medicine · 2015Article
- Investigating associations between ICU level and quality of care in the Netherlands: reporting only SMRs is not the whole story.Intensive care medicine · 2015Article
- Comparing intensive care units by size or level.Intensive care medicine · 2015Article
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9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe relationship between the number of patients admitted to an intensive care unit (ICU) volume and mortality is currently the subject of debate. After implementation of a national guideline in 2006, all Dutch ICUs have been classified into three levels based on ICU size, patient volume, ventilation days, and staffing. The goal of this study is to investigate the association between ICU level and mortality of ICU patients in the Netherlands.
methodsWe analyzed data from 132,159 patients admitted to 87 ICUs between January 1, 2009 and October 1, 2011. Logistic GEE analyses were performed to assess the influence of ICU level on in-hospital mortality and 90-day mortality in the total ICU population and in different ICU subgroups while adjusting for severity of illness by APACHE IV.
resultsNo significant differences were found in the adjusted in-hospital mortality of the total ICU population and in different subgroups admitted to level 1, 2 and 3 ICUs. In-hospital mortality in level 2 and 3 ICUs as opposed to level 1 ICUs was 1.06 (0.93-1.22) and 1.10 (0.94-1.29), respectively, and 90-day mortality was 0.92 (0.80-1.06) and 1.01 (0.88-1.17).
conclusionWe demonstrated that ICU level was not associated with significant differences in the case-mix adjusted in-hospital and long-term mortality of ICU patients. This finding is in contrast with some earlier studies suggesting a volume-outcome relationship. Our results may be explained by the successful implementation of nationwide mandatory quality requirements and adequate staffing in all three levels of ICUs over the last years.
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