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首页> 外文期刊>Critical care medicine >Comparison of community and referral intensive care unit patients in a tertiary medical center: evidence for referral bias in the critically ill.
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Comparison of community and referral intensive care unit patients in a tertiary medical center: evidence for referral bias in the critically ill.

机译：三级医疗中心社区和转诊重症监护病房患者的比较：重症患者转诊偏倚的证据。

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OBJECTIVE: To determine the existence of referral bias in the critically ill by comparing the clinical and epidemiologic characteristics of community (Olmsted County, MN residents) and referral (non-Olmsted County residents) patients admitted to the intensive care unit. DESIGN: Retrospective, cohort study. SETTING: Academic tertiary care medical center. PATIENTS: Patients admitted to the medical and surgical intensive care units at Mayo Medical Center from 1995 to 2004. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Residency status, demographics, Acute Physiology and Chronic Health Evaluation III score, intensive care unit admission diagnosis and treatment status, intensive care unit and hospital mortality, length of stay, and travel distances to Mayo Clinic. Referral patients with a medical intensive care unit admission were more severely ill, had greater mortality rates and length of stay and were more likely to receive an active intensive care unit intervention compared with community patients (p < 0.0001). Referral and community patients who had a surgical intensive care unit admission had similar severity of illness, length of stay, and intensive care unit mortality rate. Hospital mortality rate was lower in the referral surgical patients compared with community surgical patients (p = 0.0001). When adjusted for severity of illness, intensity of treatment, and admission source, community and referral medical intensive care unit patients had a similar risk of hospital death, whereas referral surgical patients had a lower risk of hospital death compared with community patients. Referral patients who had a medical intensive care unit admission and traveled greater distances to Mayo Clinic had greater mortality rates and length of stay; those who had a surgical intensive care unit admission and traveled greater distances had lower mortalities and length of stay. CONCLUSIONS: Patients who resided outside of our local community and who had medical admissions to the intensive care unit were more severelyill, had greater mortality rates, and had longer length of stay compared with community patients. Our findings support the existence of referral bias in critically ill medical patients at our tertiary medical center.
机译：目的：通过比较重症监护病房的社区患者（明尼苏达州奥姆斯特德县）和转诊患者（非奥姆斯特德县居民）的临床和流行病学特征，确定重症患者是否存在转诊偏倚。设计：回顾性队列研究。单位：三级学术医疗中心。患者：1995年至2004年进入梅奥医学中心医疗和外科重症监护室的患者。干预措施：无。测量和主要结果：住院状态，人口统计学，急性生理学和慢性健康评估III得分，重症监护病房的入院诊断和治疗状态，重症监护病房和医院的死亡率，住院时间以及到梅奥诊所的旅行距离。与社区患者相比，转诊有重症监护病房的患者病情更重，死亡率和住院时间更长，并且更有可能接受积极的重症监护病房干预（p <0.0001）。接受外科重症监护病房住院的转诊和社区患者的病情严重程度，住院时间和重症监护病房死亡率相似。与社区手术患者相比，转诊手术患者的医院死亡率更低（p = 0.0001）。在对疾病的严重程度，治疗强度和入院来源进行调整后，社区和转诊医疗重症监护病房患者的住院死亡风险相似，而与社区患者相比，转诊外科手术患者的住院死亡风险较低。接受重症监护病房转诊且到Mayo诊所的距离更远的转诊患者的死亡率和住院时间更长;那些接受外科重症监护病房住院并且走了更远距离的人的死亡率和住院时间都较低。结论：与社区患者相比，居住在我们当地社区之外并且在重症监护室就医的患者病情更重，死亡率更高，住院时间更长。我们的研究结果支持我们三级医疗中心的重症医学患者存在转诊偏见。

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