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Editorial
April 14, 1999

Reorganizing the Delivery of Intensive Care May Improve Patient Outcomes

Author Affiliations

Author Affiliation: Departments of Pediatrics and Anesthesia, Harvard Medical School and Children's Hospital, Boston, Mass.

JAMA. 1999;281(14):1330-1331. doi:10.1001/jama.281.14.1330

The task of clearly demonstrating that the type of care delivered in an intensive care unit (ICU) ultimately affects patient outcomes is a challenge. It rarely is feasible to manipulate already-established ICU characteristics. Randomly assigning patients to ICUs that do or do not have certain organizational features, such as ICU subspecialists performing daily patient rounds or nurse-to-patient ratios of less than 1:2, is logistically complex. Therefore, investigators who wish to explore the relationship between patient outcome and the structure and function of ICUs need to extract data from large databases that contain a representative sample of ICUs, identify their organizational characteristics, and use risk adjustment methods1 to evaluate the association of these characteristics with the health outcomes of interest. Risk adjustment ideally takes into account underlying differences in the pre-ICU care patient population among ICUs, the individual performance of each ICU, and differences in post-ICU care for outcomes measured beyond the ICU stay.

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