Editorial

Can Intensive Primary Care Prevent Primary Intensive Care?

Authors: David E. Taylor, MD

Abstract

In these days of increasing medical costs, the health care system is paying more attention to resource use and cost avoidance. Nowhere is this effort more tangible than in the intensive care unit (ICU), where costs account for as much as 20% of health care expenditures in the United States. To control costs and optimize bed use, most hospitals have formulated criteria for admission, discharge, and transfer from the ICU. Despite these administrative efforts, few studies have investigated the effect of these guidelines on the care of critically ill patients. 1,2

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References

1. Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y, et al; The PROTOCETIC Group. Compliance with triage to intensive care recommendations. Crit Care Med 2001; 29: 2132–2136.
 
2. Metcalfe MA, Sloggett A, McPherson K. Mortality among appropriately referred patients refused admission to intensive-care units. Lancet 1997; 350: 7–11.
 
3. Soulen JL, Duggan AK, DeAngelis CD. Identification of potentially avoidable pediatric hospital use: Admitting physician judgment as a complement to utilization review. Pediatrics 1994; 94: 421–424.
 
4. Eriksen BO, Kristiansen IS, Nord E, Pape JF, Almdahl SM, Hensrud A, et al. The cost of inappropriate admissions: A study of health benefits and resource utilization in a department of internal medicine. J Intern Med 1999; 246: 379–387.
 
5. Perneger TV, Chopard P, Sarasin FP, Gaspoz JM, Lovis C, Unger PF, et al. Risk factors for a medically inappropriate admission to a department of internal medicine. Arch Intern Med 1997; 157: 1495–1500.
 
6. Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, et al. Preventable hospitalizations and access to health care. JAMA 1995; 274: 305–311.
 
7. Parchman ML, Culler S. Primary care physicians and avoidable hospitalizations. J Fam Pract 1994; 39: 123–128.
 
8. Burr J, Sherman G, Prentice D, Hill C, Fraser V, Kollef MH. Ambulatory care-sensitive conditions: Clinical outcomes and impact on intensive care unit resource use. South Med J 2003; 96 (2).
 
9. Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations. Health Aff (Millwood) 1996; 15: 239–249.
 
10. Darchy B, Le Miere E, Figueredo B, Bavoux E, Domart Y. Iatrogenic diseases as a reason for admission to the intensive care unit: Incidence, causes, and consequences. Arch Intern Med 1999; 159: 71–78.