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1.
Intensive Care Med ; 22(7): 664-9, 1996 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-8844231

RESUMEN

OBJECTIVE: To test the hypothesis that technology availability, staffing, and diagnostic diversity in an intensive care unit (ICU) are associated with the ability to decrease hospital mortality. DESIGN: Prospective multicenter descriptive cohort study. SETTING: Ten Brazilian medical-surgical ICUs. PATIENTS: 1734 consecutive adult ICU admissions. MEASUREMENTS AND RESULTS: We recorded the amount of technology, number of diagnoses, and availability of nurses at each ICU. We also used demographic, clinical and physiologic information for an average of 173 admissions to each ICU to calculate standardized mortality ratios (SMRs) for each ICU. The mean SMR for the ten ICUs was 1.67 (range 1.01-2.30). A greater availability of ICU equipment and services was significantly (p < 0.001) associated with a lower SMR. CONCLUSION: The ability of Brazilian ICUs to reduce hospital mortality is associated with the amount of technology available in these units.


Asunto(s)
Cuidados Críticos/organización & administración , Difusión de Innovaciones , Recursos en Salud/normas , Mortalidad Hospitalaria , Ciencia del Laboratorio Clínico , Calidad de la Atención de Salud , Adulto , Brasil , Estudios de Cohortes , Investigación sobre Servicios de Salud , Humanos , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos
2.
Intensive Care Med ; 22(6): 564-70, 1996 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-8814472

RESUMEN

OBJECTIVE: To compare patients and their outcomes at ten Brazilian intensive care units (ICUs) with those reported from the United States. DESIGN: Prospective multicenter inception cohort study. SETTING: Ten Brazilian adult medical-surgical ICUs. PATIENTS: 1734 consecutive adult ICU admissions. MEASUREMENTS AND RESULTS: We used demographic, clinical and physiologic information and the APACHE III prognostic system to predict risk of hospital death for 1734 ICU admissions. We then divided the observed by the predicted hospital death rate to calculate standardized mortality ratios (SMRs) for patient groups and each ICU. Hospital mortality for Brazilian patients (34%) was double that found in the United States (17%, p < 0.01). Discrimination of survivors from non-survivors using APACHE III was good (area under a receiver operating characteristic curve = 0.82), but the predicted risk of death was significantly (p < 0.0001) lower than observed outcome (SMR = 1.67). Three of the ten Brazilian ICUs, however, had SMRs of 1.01 to 1.1 and no significant difference between observed and predicted outcomes; the remaining seven ICUs had significantly higher SMRs, ranging from 1.50 to 2.30. CONCLUSION: The APACHE III prognostic system was a good discriminator of hospital mortality for ICU admissions at 10 Brazilian ICUs. There was substantial and significant variation, however, in SMRs among the Brazilian ICUs, which suggests that further evaluations of international differences in intensive care using a common risk assessment system should be performed and factors associated with variations in risk-adjusted mortality scrutinized.


Asunto(s)
APACHE , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Evaluación de Resultado en la Atención de Salud , Adulto , Brasil , Distribución de Chi-Cuadrado , Humanos , Pronóstico , Estudios Prospectivos , Calidad de la Atención de Salud , Análisis de Supervivencia , Estados Unidos
3.
Intensive Care World ; 8(1): 35-8, 1991 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-10148199

RESUMEN

This paper summarizes the APACHE III Study now being performed by the ICU Research Unit at the George Washington University Medical Center. It presents a review of the material included in a recent detailed description of the APACHE III Study and introduces new work being developed with data from Brazilian hospitals.


Asunto(s)
Cuidados Críticos/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Brasil , Cuidados Críticos/organización & administración , Recolección de Datos/métodos , Humanos , Pronóstico , Proyectos de Investigación , Resultado del Tratamiento , Estados Unidos
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