Differences in Care Provided in Intensive Care Units (ICUs) With Physician Versus Nurse Practitioner First Responders

Process and Outcome Differences in Care Provided in Intensive Care Units (ICUs) With Physician Versus Nurse Practitioner First Responders

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.

Study Overview

• Status: Completed
• Conditions: Critical Illness
• Intervention / Treatment: Other: Medically directed care

Detailed Description

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.

• Study Type: Observational
• Enrollment (Actual): 3659

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Columbus, Ohio, United States, 43015
      • The Ohio State University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Any patients being seen at designated ICU during the time period being investigated.

Description

Inclusion Criteria:

• Patients admitted to designated ICU between September 1, 2007 and September 30, 2010.

Exclusion Criteria:

• Not admitted to designated ICU.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Traditional; ICU staffed by a resident, pulmonary fellow and attending	Other: Medically directed care; There is no research directed care. Patients are treated as medically indicated.
Non-Traditional; ICU staffed by Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending	Other: Medically directed care; There is no research directed care. Patients are treated as medically indicated.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intensive Care Unit (ICU) mortality		2007 - 2010
Hospital mortality		2007 - 2010
Time to death		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); Sedation holidays; Spontaneous breathing trials; Days with continuous infusions of sedatives; Head of bed elevation	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

Collaborators and Investigators

• Sponsor: Naeem Ali, MD
• Investigators: Principal Investigator: Naeem Ali, M.D., Ohio State University

Publications and helpful links

General Publications

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.

Study record dates

Study Major Dates

• Study Start: March 1, 2011
• Primary Completion (Actual): May 1, 2014
• Study Completion (Actual): May 1, 2014

Study Registration Dates

• First Submitted: March 24, 2011
• First Submitted That Met QC Criteria: March 24, 2011
• First Posted (Estimate): March 28, 2011

Study Record Updates

• Last Update Posted (Estimate): June 27, 2014
• Last Update Submitted That Met QC Criteria: June 25, 2014
• Last Verified: June 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Critical Illness
• Other Study ID Numbers: 2009H0145