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ICU Expense Doesn't Affect Length of Stay, Death Risk

Study suggests that spending more isn't the key to better outcomes

FRIDAY, Dec. 1, 2006 (HealthDay News) -- The amount of money spent on treating intensive care patients doesn't affect the length of their stay or their likelihood of dying, a U.S. study says.

Researchers in Cleveland looked at the care costs for nearly 1,200 patients treated by nine intensivists over 29 months in one intensive care unit (ICU). Average daily discretionary costs varied by 43 percent, or $1,003 per admission, between the intensivists who spent the most on patient care and those who spent the least.

The highest-spending doctors spend more on pharmacy, radiology, laboratory, blood banking and echocardiography, the study found.

"In this single ICU, we demonstrated large differences in resource use that are attributable to differences in physicians' practice styles," researcher Dr. Allan Garland, division of pulmonary and critical care medicine, MetroHealth Medical Center in Cleveland, said in a prepared statement.

"Higher-spending intensivists did not generate better outcomes than their lower-spending colleagues, so it may be possible to reduce ICU costs without worsening outcomes by altering their practice styles," Garland said.

Contrary to their expectations, he and his colleagues found that intensivists had a good idea of the ICU costs they incurred when treating patients.

"Perhaps the higher spenders believe their practice style produces better outcomes. Alternatively, practice styles may derive from a complex interaction between training and personality traits, such as response to uncertainty," Garland said.

The study is in the first issue for December of the American Journal of Respiratory and Critical Care Medicine.

The ICU is a major contributor to health care costs in the United States, noted an accompanying editorial.

"The ICU is a resource-intensive environment where new drugs, expensive technologies and specialized clinical care all contribute to dramatic health care expenditures. Reducing the costs of health care in general and intensive care in particular is a priority for physicians, hospital administrators and policy makers," wrote Dr. Jeremy Kahn of the University of Pennsylvania and Dr. Derek C. Angus of the University of Pittsburgh School of Medicine.

"Perhaps the greatest lesson of the Garland study is that cost control is not just the work of the health policy expert or hospital administrator -- it is also the task of individual ICU clinicians. It is now clearer than ever that accepting that task is a difficult but necessary part of critical care in the twenty-first century," they wrote.

More information

The National Library of Medicine has more about critical care.

SOURCE: American Thoracic Society, news release, Dec. 1, 2006
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