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KANSAS CITY, Mo., July 2, 2013 (GLOBE NEWSWIRE) -- New research from
Cerner Corp. (Nasdaq:CERN) shows that by incorporating patient illness severity into inter-hospital ICU comparisons, government agencies can obtain an evenhanded assessment of an ICU's performance. A recently-published research study from Cerner examined how hospitals' ICUs are evaluated and compared based on patient outcomes.
The January issue of
Critical Care Medicine contained a Feature Article entitled "
The Association between Intensive Care Unit Readmission Rate and Patient Outcomes" by Dr. Andrew Kramer, Ph.D., of Cerner, Dr. Thomas Higgins of Baystate Medical Center and Dr. Jack Zimmerman of George Washington University. The study examined whether readmission rates were a good indicator of ICU performance after adjusting for patient case-mix.
Using data on 263,000 admissions across 105 ICUs using the
APACHE® Outcomes system, the team first confirmed that units with a higher readmission rate generally had higher patient mortality and length of stay. However, when the observed outcomes are compared with what was predicted by
APACHE Outcomes, units with a high readmission rate performed much like the units with a low readmission rate. ICUs had mortality rates and average lengths of stay consistent with what was predicted based on patient case-mix, regardless of readmission rate. Given these and other findings, the team concluded that using readmission rate by itself as a quality benchmark for comparing ICUs might be a misguided action.
"It's tempting to assume that there's a relationship between a hospital's ICU readmission rate and quality of care," says Dr. Thomas Higgins, vice-chair of clinical affairs in the department of medicine at Baystate Medical Center, and one of the study's authors. "But, there are a number of reasons why a patient might be at higher risk for ICU readmission: advanced age, low physiologic reserve, complexity of their medical condition, tenuous fluid status in dialysis patients, or emergency surgery where preoperative stabilization was impossible. This study allowed us to evaluate ICU readmissions on a level playing field using
APACHE IV to adjust for case-mix. Severity-adjusted mortality or length-of-stay did not correlate at all with readmission rates, implying that patient factors, rather than hospital management protocols account for much of the spread seen in ICU readmission rates."
"Hospitals and ICUs are being ranked based on their mortality rate and 30 day readmission rate, respectively. One consequence of this unadjusted comparison is that hospitals and intensive care units (ICUs) which admit sicker patients are unfairly punished," noted Dr. Kramer, senior researcher with Cerner. "If the government or an associated regulatory body is going to evaluate hospitals or ICUs based on patient outcomes, it is necessary take the severity of illness of the patient population into account".