Mortalidad y estancia hospitalaria ajustada por gravedad como indicadores de efectividad y eficiencia de la atención de pacientes en Unidades de Cuidados Intensivos

Objective. To evaluate effectiveness and efficiency of ICU care using the APACHE III model customized for Spain.Desing. Prospective, observational, multi-centre cohort study.Setting. Nine Spanish ICUs.Patients. One thousand two hundred and eleven patients admitted consecutively. Patients under 16 years of age, patients admitted for less than 24 hours, patients admitted for definitive pacemaker implant and ICU readmissions within the same hospital stay were excluded.Primary endpoints. All the necessary endpoints to calculate the APACHE III score and predicted mortality risk were collected. The Standardized Mortality Ratio (SMR) was calculated. The Actual Weighted Hospital Days (AWHD) was calculated according to the patient's status and patient's location (ward or ICU). The Weighted Hospital Days Predicted (WHDP) was calculated according to the multiple regression model that provided the best explanation of the hospital stay. Later, the Standardized Resource Use Performance Index (SRUPI), computed as AWHD/WHDP, was calculated for each hospital.Results. The SMR was 0.9 (95% CI: 0.82-0.99), SRUPI was greater than 1 in 3 of 9 hospitals, According the SMR and SRUPI only one hospital was qualified as an outlier.Conclusions. In this study, no relationship was found between quality of care and use of resources. Moreover, this methodology may be a useful tool in order to detect deviations from the standard of care and use of resources, and in this way to lead to the analysis of different causes, the differences among hospitals being taken into account.