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Intensivists' base specialty of training is associated with variations in mortality and practice patterns

INTRODUCTION: Current evidence regarding whether the staffing of intensive care units (ICUs) with a trained Intensivist benefits patient outcomes is discordant. We sought to determine whether, among certified Intensivists, base specialty of training could contribute to variation in practice patterns...

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Autores principales: Billington, Emma O, Zygun, David A, Stelfox, H Tom, Peets, Adam D
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811951/
https://www.ncbi.nlm.nih.gov/pubmed/20040087
http://dx.doi.org/10.1186/cc8227
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author Billington, Emma O
Zygun, David A
Stelfox, H Tom
Peets, Adam D
author_facet Billington, Emma O
Zygun, David A
Stelfox, H Tom
Peets, Adam D
author_sort Billington, Emma O
collection PubMed
description INTRODUCTION: Current evidence regarding whether the staffing of intensive care units (ICUs) with a trained Intensivist benefits patient outcomes is discordant. We sought to determine whether, among certified Intensivists, base specialty of training could contribute to variation in practice patterns and patient outcomes in ICUs. METHODS: The records of all patients who were admitted to one of three closed multi-system ICUs within tertiary care centers in the Calgary Health Region, Alberta, Canada, during a five year period were retrospectively reviewed. Outcomes for patients admitted by Intensivists with base training in General Internal Medicine, Pulmonary Medicine, or other eligible base specialties (Anesthesia, General Surgery, and Emergency Medicine combined) were compared. RESULTS: ICU mortality in the entire cohort (n = 9,808) was 17.2% and in-hospital mortality was 32.0%. After controlling for potential confounders, ICU mortality (odds ratio (OR): 0.69; 95% confidence interval (CI): 0.52 to 0.94) was significantly lower for patients admitted by Intensivists with Pulmonary Medicine as a base specialty of training, but not ICU length of stay (LOS) (coefficient: 0.11; -0.20 to 0.42) or hospital mortality (OR: 0.88; 0.68 to 1.13). There was no difference in ICU or hospital mortality or length of stay between the three base specialty groups for patients who were admitted and managed by a single Intensivist for their entire ICU admission (n = 4,612). However, we identified significant variation in practice patterns between the three specialty groups for the number of invasive procedures performed and decisions to limit life-sustaining therapies. CONCLUSIONS: Intensivists' base specialty of training is associated with practice pattern variations. This may contribute to differences in processes and outcomes of patient care.
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spelling pubmed-28119512010-01-28 Intensivists' base specialty of training is associated with variations in mortality and practice patterns Billington, Emma O Zygun, David A Stelfox, H Tom Peets, Adam D Crit Care Research INTRODUCTION: Current evidence regarding whether the staffing of intensive care units (ICUs) with a trained Intensivist benefits patient outcomes is discordant. We sought to determine whether, among certified Intensivists, base specialty of training could contribute to variation in practice patterns and patient outcomes in ICUs. METHODS: The records of all patients who were admitted to one of three closed multi-system ICUs within tertiary care centers in the Calgary Health Region, Alberta, Canada, during a five year period were retrospectively reviewed. Outcomes for patients admitted by Intensivists with base training in General Internal Medicine, Pulmonary Medicine, or other eligible base specialties (Anesthesia, General Surgery, and Emergency Medicine combined) were compared. RESULTS: ICU mortality in the entire cohort (n = 9,808) was 17.2% and in-hospital mortality was 32.0%. After controlling for potential confounders, ICU mortality (odds ratio (OR): 0.69; 95% confidence interval (CI): 0.52 to 0.94) was significantly lower for patients admitted by Intensivists with Pulmonary Medicine as a base specialty of training, but not ICU length of stay (LOS) (coefficient: 0.11; -0.20 to 0.42) or hospital mortality (OR: 0.88; 0.68 to 1.13). There was no difference in ICU or hospital mortality or length of stay between the three base specialty groups for patients who were admitted and managed by a single Intensivist for their entire ICU admission (n = 4,612). However, we identified significant variation in practice patterns between the three specialty groups for the number of invasive procedures performed and decisions to limit life-sustaining therapies. CONCLUSIONS: Intensivists' base specialty of training is associated with practice pattern variations. This may contribute to differences in processes and outcomes of patient care. BioMed Central 2009 2009-12-29 /pmc/articles/PMC2811951/ /pubmed/20040087 http://dx.doi.org/10.1186/cc8227 Text en Copyright ©2009 Billington et al; BioMed Central Ltd http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Billington, Emma O
Zygun, David A
Stelfox, H Tom
Peets, Adam D
Intensivists' base specialty of training is associated with variations in mortality and practice patterns
title Intensivists' base specialty of training is associated with variations in mortality and practice patterns
title_full Intensivists' base specialty of training is associated with variations in mortality and practice patterns
title_fullStr Intensivists' base specialty of training is associated with variations in mortality and practice patterns
title_full_unstemmed Intensivists' base specialty of training is associated with variations in mortality and practice patterns
title_short Intensivists' base specialty of training is associated with variations in mortality and practice patterns
title_sort intensivists' base specialty of training is associated with variations in mortality and practice patterns
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811951/
https://www.ncbi.nlm.nih.gov/pubmed/20040087
http://dx.doi.org/10.1186/cc8227
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