ArticleJournal of intensive care2024
Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation.
Article in Journal of intensive care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- The ICUPASS Study: Variability, Influencing Factors, and Clinician Stress in ICU Admission Decisions.Cureus · 2026Article
- Critical care access and outcomes in residents of inpatient-care catchment areas with and without ICUs: a nationwide cohort study in Japan.The Lancet regional health. Western Pacific · 2026Article
- Nationwide Comparison of ICU Procedure Frequencies in Japan Using a Public Open Database: A Cross-Sectional Study by ICU Admission Fee Type and Region.Journal of clinical medicine · 2026Article
- Predictors of adult ICU mortality: a retrospective study at two government hospitals in Ethiopia.Scientific reports · 2026Article
- National cost of intensive care in Japan from 2018 to 2022.Journal of intensive care · 2026Article
- Hospitalization after Initial Telemedicine Versus in-Person Consultation for Outpatients with Respiratory or Digestive Diseases: A Retrospective Cohort Study.JMA journal · 2026Article
- Deep Learning-Based 30-Day Mortality Prediction in Critically Ill Bone and Bone Marrow Metastasis Patients: A Multicenter Retrospective Cohort Study.Current oncology (Toronto, Ont.) · 2025Article
- In-hospital mortality of patients admitted to the intermediate care unit in hospitals with and without an intensive care unit: a nationwide inpatient database study.Critical care (London, England) · 2025Article
- Reply to the comment by Sakamoto et al. on "The method to identify invasive mechanical ventilation with Japanese claim data".Journal of intensive care · 2024Article
- The method to identify invasive mechanical ventilation with Japanese claim data.Journal of intensive care · 2024Article
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9 authors.
Funding
Abstract
backgroundPatients who receive invasive mechanical ventilation (IMV) in the intensive care unit (ICU) have exhibited lower in-hospital mortality rates than those who are treated outside. However, the patient-, hospital-, and regional factors influencing the ICU admission of patients with IMV have not been quantitatively examined.
methodsThis retrospective cohort study used data from the nationwide Japanese inpatient administrative database and medical facility statistics. We included patients aged ≥ 15 years who underwent IMV between April 2018 and March 2019. The primary outcome was ICU admission on the day of IMV initiation. Multilevel logistic regression analyses incorporating patient-, hospital-, or regional-level variables were used to assess cluster effects by calculating the intraclass correlation coefficient (ICC), median odds ratio (MOR), and proportional change in variance (PCV).
resultsAmong 83,346 eligible patients from 546 hospitals across 140 areas, 40.4% were treated in ICUs on their IMV start day. ICU admission rates varied widely between hospitals (median 0.7%, interquartile range 0-44.5%) and regions (median 28.7%, interquartile range 0.9-46.2%). Multilevel analyses revealed significant effects of hospital cluster (ICC 82.2% and MOR 41.4) and regional cluster (ICC 67.3% and MOR 12.0). Including patient-level variables did not change these ICCs and MORs, with a PCV of 2.3% and - 1.0%, respectively. Further adjustment for hospital- and regional-level variables decreased the ICC and MOR, with a PCV of 95.2% and 85.6%, respectively. Among the hospital- and regional-level variables, hospitals with ICU beds and regions with ICU beds had a statistically significant and strong association with ICU admission.
conclusionsOur results revealed that primarily hospital and regional factors, rather than patient-related ones, opposed ICU admissions for patients with IMV. This has important implications for healthcare policymakers planning interventions for optimal ICU resource allocation.
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