Are Hospitals Overdosing on Intensive Care?

Intensivists and Patient Mortality

This is an interesting twist in the trend of ICU data. My suspicion is that the answer is more basic. On average in today's hospitals, sicker patients get taken care of by intensivists. The clinical indication of severity that necessitates intensive care readily confounds the ability to make comparisions (ie Indicational Confounding). Unfortunately, this is not readily accounted for in regression models.

So, it's likely back to the basics: sicker patients die more frequently; Intensivists take care of sicker patients; Patients of intensivists are more likely to die. QED.

Intensivists increases mortality

This is an interestng paper, however the critically ill patients have so many variables that makes it difficult to evaluate and study. I expect further analysis of this data and also a lot more investigations to prove or disprove this information.

study criteria

I read the paper this AM. Unfortunately, to be analyzed as a patient cared for by an "intensivist," you merely needed one encounter recorded. THerefore, it says nothing about the system of care, as the authors point out. A closed unit vs. open unit with criitical care docs episodically visiting are equivalent in their analysys. I think the conclusions are thought provoking, but my sense is the findings will be overhyped with clearly understanding what is being examined.