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Cerner® Research Shows How APACHE® Outcomes Properly Analyzes ICU Performance for Benchmarking


Study reveals perils of comparison without adjusting for patient case mix

KANSAS CITY, Mo. — — New research from Cerner Corp. (Nasdaq: CERN) shows that by incorporating patient illness severity into inter-hospital ICU comparisons, government agencies can obtain an evenhanded assessment of an ICU’s performance. A recently-published research study from Cerner examined how hospitals’ ICUs are evaluated and compared based on patient outcomes.

The January issue of Critical Care Medicine contained a Feature Article entitled “The Association between Intensive Care Unit Readmission Rate and Patient Outcomes” by Dr. Andrew Kramer, Ph.D., of Cerner, Dr. Thomas Higgins of Baystate Medical Center and Dr. Jack Zimmerman of George Washington University. The study examined whether readmission rates were a good indicator of ICU performance after adjusting for patient case-mix.

Using data on 263,000 admissions across 105 ICUs using the APACHE® Outcomes system, the team first confirmed that units with a higher readmission rate generally had higher patient mortality and length of stay. However, when the observed outcomes are compared with what was predicted by APACHE Outcomes, units with a high readmission rate performed much like the units with a low readmission rate. ICUs had mortality rates and average lengths of stay consistent with what was predicted based on patient case-mix, regardless of readmission rate. Given these and other findings, the team concluded that using readmission rate by itself as a quality benchmark for comparing ICUs might be a misguided action.

“It’s tempting to assume that there’s a relationship between a hospital’s ICU readmission rate and quality of care” says Dr. Thomas Higgins, vice-chair of clinical affairs in the department of medicine at Baystate Medical Center, and one of the study’s authors. “But, there are a number of reasons why a patient might be at higher risk for ICU readmission: advanced age, low physiologic reserve, complexity of their medical condition, tenuous fluid status in dialysis patients, or emergency surgery where preoperative stabilization was impossible. This study allowed us to evaluate ICU readmissions on a level playing field using APACHE IV to adjust for case-mix. Severity-adjusted mortality or length-of-stay did not correlate at all with readmission rates, implying that patient factors, rather than hospital management protocols account for much of the spread seen in ICU readmission rates.”

“Hospitals and ICUs are being ranked based on their mortality rate and 30 day readmission rate, respectively. One consequence of this unadjusted comparison is that hospitals and intensive care units (ICUs) which admit sicker patients are unfairly punished,” noted Dr. Kramer, senior researcher with Cerner. “If the government or an associated regulatory body is going to evaluate hospitals or ICUs based on patient outcomes, it is necessary take the severity of illness of the patient population into account”.

The study by Kramer et al. utilized data collected from Cerner’s APACHE Outcomes solution. APACHE Outcomes provides true quality measures for measuring and improving ICU patient outcomes and delivers severity-adjusted predictions to anticipate patient needs and effectively allocate resources.

APACHE Outcomes:

-Presents unit-level and patient-level information at-a-glance;
-Provides access to the largest outcomes database in the world for measuring your ICU’s performance;
-Leverages the detailed patient info available to help ICUs increase efficiency; and
-Integrates with any EHR.

APACHE is the most widely utilized clinical prediction tool among adult ICUs for evaluating expected outcomes such as: length of stay, mortality, ventilator days and need for active treatment. The APACHE methodology has been cited more than 4,000 times in articles and research published in leading industry trade journals.

About Cerner

Cerner is contributing to the systemic change of health and care delivery. For more than 30 years Cerner has been executing its vision to make health care safer and more efficient. We started with the foundation of digitizing paper processes and now offer the most comprehensive array of information software, professional services, medical device integration, remote hosting and employer health and wellness services. Cerner systems are used by everyone from individual consumers, to single-doctor practices, hospitals, employers and entire countries. Taking what we’ve learned over more than three decades, Cerner is building on the knowledge that is in the system to support evidence-based clinical decisions, prevent medical errors and empower patients in their care.

Cerner® solutions are licensed by approximately 10,000 facilities around the world, including more than 2,700 hospitals; 4,150 physician practices; 45,000 physicians; 550 ambulatory facilities, such as laboratories, ambulatory centers, behavioral health centers, cardiac facilities, radiology clinics and surgery centers; 800 home health facilities; 45 employer sites and 1,750 retail pharmacies.

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