The effect of race and ethnicity on outcomes among patients in the intensive care unit: a comprehensive study involving socioeconomic status and resuscitation preferences.

Objective: We sought to determine whether race or ethnicity is independently associated with mortality or intensive care unit length of stay among critically ill patients after accounting for patients' clinical and demographic characteristics including socioeconomic status and resuscitation preferences.

Design: Historical cohort study of patients hospitalized in intensive care units.

Setting: Adult intensive care units in 35 California hospitals during the years 2001-2004.

Predictors of early postdischarge mortality in critically ill patients: a retrospective cohort study from the California Intensive Care Outcomes project.

Purpose: Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early postdischarge mortality contributes significantly to overall 30-day mortality. Factors associated with early postdischarge mortality are unknown.

Relationship between discharge practices and intensive care unit in-hospital mortality performance: evidence of a discharge bias.

Context: Current intensive care unit performance measures include in-hospital mortality after intensive care unit admission. This measure does not account for deaths occurring after transfer to another hospital or soon after discharge and therefore, may be biased.

Objective: Determine how transfer rates to other acute care hospitals and early post-discharge mortality rates impact hospital performance assessments using an in-hospital mortality model.

Mortality probability model III and simplified acute physiology score II: assessing their value in predicting length of stay and comparison to APACHE IV.

Background: To develop and compare ICU length-of-stay (LOS) risk-adjustment models using three commonly used mortality or LOS prediction models.

Methods: Between 2001 and 2004, we performed a retrospective, observational study of 11,295 ICU patients from 35 hospitals in the California Intensive Care Outcomes Project. We compared the accuracy of the following three LOS models: a recalibrated acute physiology and chronic health evaluation (APACHE) IV-LOS model; and models developed using risk factors in the mortality probability model III at zero hours (MPM(0)) and the simplified acute physiology score (SAPS) II mortality prediction model.

Variation in ICU risk-adjusted mortality: impact of methods of assessment and potential confounders.

Background: Federal and state agencies are considering ICU performance assessment and public reporting; however, an accurate method for measuring performance must be selected. In this study, we determine whether a substantial variation in ICU mortality performance still exists in modern ICUs, and compare the predictive accuracy, reliability, and data burden of existing ICU risk-adjustment models.

Methods: A retrospective chart review of 11,300 ICU patients from 35 California hospitals from 2001 to 2004 was performed.

The relationship of insurance status, hospital ownership, and teaching status with interhospital transfers in California in 2000.

Purpose: Public hospitals and academic medical centers may admit more poorly insured transfer patients than do other institutions. The authors investigated the relationship of patient insurance status, hospital ownership, and hospital teaching status with interhospital transfers in California.

Method: In 2003, data were derived from the hospital discharge abstract database for the year 2000 from the California Office of Statewide Health Planning and Development.

Differences in mortality among patients with community-acquired pneumonia in California by ethnicity and hospital characteristics.

Purpose: To determine ethnic disparities in mortality for patients with community-acquired pneumonia, and the potential effects of hospital characteristics on disparities, we compared the risk-adjusted mortality of white, African American, Hispanic, and Asian American patients hospitalized for community-acquired pneumonia.

Methods: We studied patients discharged with community-acquired pneumonia in 1996 from an acute care hospital in California (n = 54,874). Logistic regression models were used to examine the association between ethnicity and hospital characteristics and 30-day mortality after adjusting for clinical characteristics.

The best of both worlds? Potential of hybrid prospective/concurrent risk adjustment.

Background: There remains considerable uncertainty about whether prospective or concurrent risk adjustment (RA) is preferable. Although concurrent models have better predictive power than prospective models, the large payments associated with concurrent RA create incentives for fraudulent coding. A hybrid strategy--in which prospective payments were used for patients with low expected costs and concurrent payments were available upon the diagnosis of a small number of common, expensive conditions--might improve predictive performance while requiring less auditing than fully concurrent RA.