Variation in use of intensive care for adults with diabetic ketoacidosis
Critical Care Medicine, 06/20/2012
Gershengorn HB et al. – The authors observed variations across hospitals in the use of intensive care for diabetic ketoacidosis patients that was not associated with differences in–hospital length of stay or mortality. Institutional practice patterns appear to impact admission decisions and represent a potential target for reduction of resource utilization in higher use institutions.Methods
- Fifteen thousand nine hundred ninety–four adult (≥18) hospital admissions with a primary diagnosis of diabetic ketoacidosis.
- The authors calculated reliability– and risk–adjusted intensive care unit utilization, hospital length of stay, and mortality.
- They identified hospital–level factors associated with increased likelihood of intensive care unit admission after controlling patient characteristics using multilevel, mixed–effects logistic regression analyses; they assessed the amount of residual variation in intensive care unit utilization using the intraclass correlation coefficient.
- Use of intensive care for diabetic ketoacidosis patients varied widely across hospitals (adjusted range: 2.1% to 87.7%), but was not associated with hospital length of stay or mortality.
- After multilevel adjustment, hospitals with a high volume of diabetic ketoacidosis admissions admitted diabetic ketoacidosis patients to the intensive care unit less often (odds ratio 0.40, p=.002, highest quintile compared to lowest), whereas hospitals with higher rates of intensive care unit utilization for all nondiabetic ketoacidosis in–patients admitted diabetic ketoacidosis patients to the intensive care unit more frequently (odds ratio 1.31, p=.001, for each additional 10% increase).
- In the multilevel model, more than half (58%) of the variation in the intensive care unit admission practice attributable to hospitals remained unexplained.