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Study: ICU Use Associated With More Invasive Procedures, Higher Costs

ICU admissions lack clear-cut guidelines

A study of four common medical conditions suggests that hospitals that used intensive care units (ICUs) more frequently were more likely to perform invasive procedures and have higher costs while showing no improvement in mortality, according to an article posted on the Medical Xpress website. The findings were published online in JAMA Internal Medicine.

The potential clinical implications of overusing ICU care, along with its high costs, have made improving the value of ICU care an imperative for the United States health care system. However, variability exists in ICU use among hospitals because of the lack of clear-cut guidelines for ICU admission and because of differences in hospital resources, policies, and culture.

Researchers analyzed ICU use for four common medical conditions: diabetic ketoacidosis (DKA), pulmonary embolism (PE), congestive heart failure (CHF), and upper gastrointestinal bleeding (UGIB).

The study included data for 156,842 hospitalizations at 94 hospitals for those four conditions in Washington state and Maryland from 2010 to 2012, accounting for 4.7% of total hospitalizations at those hospitals.

The authors examined ICU utilization rates, hospital mortality, the use of invasive procedures, and hospital costs. They reported that ICU admission rates ranged from 16% to 81% for DKA; from 5% to 44% for PE; from 12% to 51% for UGIB; and from 4% to 49% for CHF. Smaller hospitals with fewer beds had higher ICU utilization more often, as did teaching hospitals, according to the study.

While ICU use was not associated with significant differences in hospital mortality, it was associated with more invasive procedures and higher costs, the authors found. For example, rates of invasive therapies in all four conditions were greater in hospitals with higher ICU use. In addition, hospitalization costs among lower and higher ICU hospitals were $7,141 and $8,204, respectively, for DKA; $10,660 and $11,117 for PE; $10,164 and $10,851 for UGIB; and $10,175 and $13,587 for CHF, according to the results.

The authors noted study limitations related to the data, including a lack of detail to account fully for medical complexity.

“In summary, hospitals that utilized ICU care more frequently for DKA, PE, UGIB, and CHF were more likely to perform invasive studies and have higher hospital costs with no improvement in mortality compared with lower ICU utilization institutions. These findings suggest that optimizing ICU utilization may improve quality and value of ICU care, but accomplishing that will require institutional assessments of factors that lead clinicians to admit patients to the ICU for cases in which that level of care may not be necessary,” the authors conclude.

Sources: Medical Xpress; August 8, 2016; and JAMA Internal Medicine; August 8, 2016.

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