ArticleCritical care medicine2017
Hospital Contributions to Variability in the Use of ICUs Among Elderly Medicare Recipients.
Article in Critical care medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 19 citations in OpenAlex.
- The ICUPASS Study: Variability, Influencing Factors, and Clinician Stress in ICU Admission Decisions.Cureus · 2026Article
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- Methicillin-resistantAntimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Growth In Patient Cost Sharing For Hospitalizations With And Without Intensive Care Among Commercially Insured Patients.Health affairs (Project Hope) · 2023Article
- Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment.AACN advanced critical care · 2021Article
- Prediction of Acute Respiratory Failure Requiring Advanced Respiratory Support in Advance of Interventions and Treatment: A Multivariable Prediction Model From Electronic Medical Record Data.Critical care explorations · 2021Article
- Association of Hospital-Level Intensive Care Unit Use and Outcomes in Older Patients With Isolated Rib Fractures.JAMA network open · 2020Article
- Goldilocks, the Three Bears and Intensive Care Unit Utilization: Delivering Enough Intensive Care But Not Too Much. A Narrative Review.Pulmonary therapy · 2020Review
- Potentially Preventable Intensive Care Unit Admissions in the United States, 2006-2015.Annals of the American Thoracic Society · 2020Article
- Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure.Annals of the American Thoracic Society · 2019Article
- ICU Utilization for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Receiving Noninvasive Ventilation.Critical care medicine · 2019Article
- Intensivists in U.S. Acute Care Hospitals.Critical care medicine · 2019Article
- Multicenter derivation and validation of an early warning score for acute respiratory failure or death in the hospital.Critical care (London, England) · 2018Observational
- Intensive care utilization following major noncardiac surgical procedures in Ontario, Canada: a population-based study.Intensive care medicine · 2018Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
Abstract
objectiveHospitals vary widely in ICU admission rates across numerous medical diagnoses. The extent to which variability in ICU use is specific to individual diagnoses or is a function of the hospital, regardless of disease, is unknown.
designRetrospective cohort study.
settingA total of 1,120 acute care hospitals with ICU capabilities. PATIENTS: Medicare beneficiaries 65 years old or older admitted for five medical diagnoses (acute myocardial infarction, congestive heart failure, stroke, pneumonia, and chronic obstructive pulmonary disease) and a surgical diagnosis (hip fracture treated with arthroplasty) in 2010.
interventionsNone. MEASUREMENTS AND MAIN
resultsWe used multilevel models to calculate risk- and reliability-adjusted ICU admission rates, examined the correlation in ICU admission rates across diagnosis and calculated intraclass correlation coefficients and median odds ratios to quantify the variability in ICU admission rate that was attributable to hospitals. We also examined the ability of a high ICU-use hospital for one condition to predict high ICU use for other conditions. We identified 348,462 patients with one of the eligible conditions. ICU admission rates were positively correlated within hospitals for included medical diagnoses (r range, 0.38-0.59; p < 0.01). The top hospital quartile of ICU use for congestive heart failure had a sensitivity of 50-60% and specificity of 79-81% for detecting top quartile hospitals for each other conditions. After adjustment for patient and hospital characteristics, hospitals accounted for 17.6% (95% CI, 16.2-19.1%) of variability in ICU admission, corresponding to a median odds ratio of 2.3, compared to 25.8% (95% CI, 24.5-27.1%) and median odds ratio 2.8 for diagnosis. This suggests a patient with median baseline risk of ICU admission would more than double his/her odds of ICU admission if moving to a higher utilizing hospital.
conclusionsHospitals account for a significant proportion of variation independent of measured patient and hospital characteristics, suggesting the need for further work to evaluate the causes of variation at the hospital level and potential consequences of variation across hospitals.
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