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September 22/29, 2015

Assessing the Value of Intensive Care

Author Affiliations
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2 Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 3Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
JAMA. 2015;314(12):1240-1241. doi:10.1001/jama.2015.11171

Despite ongoing reform efforts, spending on hospital care in the United States remains an intractable problem.1 One strategy to lower hospital spending may be to reduce the number of intensive care unit (ICU) admissions, particularly for patients with illness of low severity who are admitted for observation rather than life-threatening organ failure.2 Spending on hospital admissions involving intensive care accounts for nearly half of all hospital costs,3 making ICU admissions an important focus for reducing overall expenditures. At the same time, there is good evidence that intensive care is overused. Hospitals vary widely in their use of the ICU without apparent differences in mortality,4 and transient reductions in the availability of ICU beds leads to fewer ICU admissions without apparent harm to patients.5 These data imply that ICU admissions for discretionary patients, patients for whom it is not clear whether they would benefit more from ICU care or from care in the general hospital ward, represent “low-value” health care—something to reduce if not eliminate all together. The usual prescriptions toward that end range from expanding the use of guidelines for ICU triage6 to forcing more judicious use by reducing the availability of ICU beds.7

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