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The purpose of this study is to evaluate and compare outcomes of patients that have received care in medical intensive care units in a tertiary care facility with two different models; the traditional model including resident, pulmonary fellow and attending physician and a nontraditional model which has Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending.
This will be a retrospective cohort study that is performed between two medical intensive care units (ICU). The goal is to compare outcomes of patients that have received care in medical intensive care units in a tertiary care facility with two different models; the traditional model including a resident, pulmonary fellow and attending and a nontraditional model which has Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending. Outcomes that will be measured include ICU length of stay, hospital length of stay after ICU discharge, ventilator days, daily spontaneous breathing trials, and daily awakening trials, as well as mortality in hospital and after discharge.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Traditional | ICU staffed by a resident, pulmonary fellow and attending |
| |
| Non-Traditional | ICU staffed by Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Medically directed care | Other | There is no research directed care. Patients are treated as medically indicated. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Life-years hospital costs | Life-years per $10,000 hospital costs - defined as the sum of days of survival after ICU admission for all patients admitted to each ICU/sum of all hospital costs for all patients admitted to each ICU | 2007 - 2010 |
| Measure | Description | Time Frame |
|---|---|---|
| Intensive Care Unit (ICU) mortality | 2007 - 2010 | |
| Hospital mortality | 2007 - 2010 | |
| Time to death |
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Inclusion Criteria:
Exclusion Criteria:
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Any patients being seen at designated ICU during the time period being investigated.
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| Name | Affiliation | Role |
|---|---|---|
| Naeem Ali, M.D. | Ohio State University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Ohio State University | Columbus | Ohio | 43015 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15640637 | Background | Cooper LM, Linde-Zwirble WT. Medicare intensive care unit use: analysis of incidence, cost, and payment. Crit Care Med. 2004 Nov;32(11):2247-53. doi: 10.1097/01.ccm.0000146301.47334.bd. | |
| 15187502 | Background | Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med. 2004 Jun;32(6):1254-9. doi: 10.1097/01.ccm.0000128577.31689.4c. |
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| ID | Term |
|---|---|
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| 2007 - 2010 |
| Ventilator Days | 2007 - 2010 |
| Ventilator-free days | Days alive and not requiring mechanical ventilation in first 28 days after ICU admission | 2007 - 2010 |
| Intensive Care Unit (ICU)-free days | Days alive and not in the ICU in first 28 days after ICU admission | 2007 - 2010 |
| Evidence-based care | % of ICU days receiving evidence-based care will also be explored as mediators of other outcomes)
| 2007 - 2010 |
| Discharge location among survivors | 2007 - 2010 |
| Intensive Care Unit (ICU)Length of Stay (LOS) | 2007 - 2010 |
| Hospital Length of Stay (LOS) | 2007 - 2010 |
| Hospital costs | 2007 - 2010 |
| Hospital charges | 2007 - 2010 |
| Patient Satisfaction Survey Results | 2007 - 2010 |
| 18766097 | Background | Kleinpell RM, Ely EW, Grabenkort R. Nurse practitioners and physician assistants in the intensive care unit: an evidence-based review. Crit Care Med. 2008 Oct;36(10):2888-97. doi: 10.1097/CCM.0b013e318186ba8c. |
| 8951267 | Background | Mitchell-DiCenso A, Guyatt G, Marrin M, Goeree R, Willan A, Southwell D, Hewson S, Paes B, Rosenbaum P, Hunsberger M, Baumann A. A controlled trial of nurse practitioners in neonatal intensive care. Pediatrics. 1996 Dec;98(6 Pt 1):1143-8. |
| 12413375 | Background | Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002 Nov 6;288(17):2151-62. doi: 10.1001/jama.288.17.2151. |
| 17556721 | Background | Treggiari MM, Martin DP, Yanez ND, Caldwell E, Hudson LD, Rubenfeld GD. Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury. Am J Respir Crit Care Med. 2007 Oct 1;176(7):685-90. doi: 10.1164/rccm.200701-165OC. Epub 2007 Jun 7. |