Advance care planning norms may contribute to hospital variation in end-of-life ICU use: a simulation study.

Background: There is wide variation in end-of-life (EOL) intensive care unit (ICU) use among academic medical centers (AMCs). Our objective was to develop hypotheses regarding medical decision-making factors underlying this variation.

Methods: This was a high-fidelity simulation experiment involving a critically and terminally ill elder, followed by a survey and debriefing cognitive interview and evaluated using triangulated quantitative-qualitative comparative analysis.

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.

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.

Central line infections.

Central venous catheters are commonly used in the critical care setting. Unfortunately, their use is often associated with complications, including fatal infections. Making the diagnosis of central venous catheter infection can be difficult.