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Home > Studies > 2000 ICU study > Methodology 100 Top Hospitals™:
ICU Benchmarks for Success — 2000
Methodology
Because ICU patients vary greatly
in both severity of illness and underlying medical problems, the
traditional variables used in our statistical models would not have been
sufficient to explain the observed variation among hospitals. For this
reason, we have explicitly tailored our analysis to address the unique
variables relevant to the ICU patient population.
THE DATABASE: The data used in the 100 Top Hospitals™: ICU Benchmarks for Success
study are from Solucient's DRG (diagnosis-related group) and hospital
databases for 1998 and 1999, the two most recent years available.
Data used to calculate the clinical measures for this study are from
the DRG database. This database is based on the publicly available
MedPAR (Medicare Provider Analysis and Review) data set from the Health
Care Financing Administration. Data from Solucient's hospital database
are also used to calculate hospital-specific cost-to-charge ratios that
are applied to ICU-related ancillary revenue center charges. The primary
source of these data is the Medicare cost report, which is filed
annually by every U.S. hospital that participates in the Medicare
program.
THE STUDY GROUP: We
stratified our patient population into three groups that cover both a
range of ICU-related procedures and diagnoses and capture different
clinical pathways through which a patient enters an ICU:
- Patients who present with medical
diagnoses, such as stroke or pneumonia ("Admission Diagnosis
Group").
- Patients who enter an ICU after
surgery ("Primary Procedure Group").
- Patients on a mechanical
ventilator for at least 4 days ("Mechanical Ventilation
Group"). These are most critically ill patients in the study.
THE COMPARISON GROUPS: Teaching and residency programs
have a profound effect on the types of patients hospitals treat and
the scope of services they provide. When analyzing the performance
of an individual hospital, it is crucial to evaluate it against
other like hospitals. Accordingly, we assigned each hospital to one
of three peer groups according to its teaching and residency program
status:
- Teaching Hospitals with Residency Programs in Critical Care
- Teaching Hospitals
- Community Hospitals
PERFORMANCE MEASURES AND SCORING: We compiled a group of nine
measures of clinical quality practices and efficiency of operations that
we believe constitutes the most reliable, scientific way possible to
produce benchmarks for superior hospital performance. The models we used
are specifically tailored to ICUs, and the four basic
measures-complications, mortality, length of stay, and costs—collectively
assess both the clinical outcomes and resource utilization of ICU units.
The measures are listed below:
- Risk-Adjusted Complications Index for Primary Procedure
Group
- Risk-Adjusted Mortality Index for Admission Diagnosis
Group
- Risk-Adjusted Mortality Index for Primary Procedure Group
- Risk-Adjusted Mortality Index for Mechanical Ventilation
Group
- Adjusted LOS for Admission Diagnosis Group
- Adjusted LOS for Primary Procedure Group
- Adjusted ICU-Related Ancillary Cost per ICU Day for Admission
Diagnosis Group
- Adjusted ICU-Related Ancillary Cost per ICU Day for Primary
Procedure Group
- Adjusted ICU-Related Ancillary Cost per ICU Day for Mechanical
Ventilation Group
Within each of the three peer groups, we scored hospitals on the basis of their
performance on each of the measures relative to other hospitals in their group. First,
each hospital was given a single score for each of the measures. These scores were
then summed to arrive at a total score for each hospital within each of the three peer
groups. Because of the vital role of quality of care in assessing a hospital, the scores
for the patient mortality and patient complications indices were double weighted, that is,
those scores were multiplied by two before being added to the other measures.
100 Top abstract and custom study
now available!
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ICU Benchmarks for Success study abstract by calling
(800) 568-3282.
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custom online study comparing a hospital with its peer groups and the ICU benchmark.
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Methodology