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Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores.

https://arctichealth.org/en/permalink/ahliterature168850
Source
J Crit Care. 2006 Jun;21(2):142-50
Publication Type
Article
Date
Jun-2006
Author
Monica Norena
Hubert Wong
Willie D Thompson
Sean P Keenan
Peter M Dodek
Author Affiliation
Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada V6Z 1Y6.
Source
J Crit Care. 2006 Jun;21(2):142-50
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
British Columbia
Comorbidity
Coronary Care Units - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Regression Analysis
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Treatment Outcome
Abstract
Comparison of outcomes among intensive care units (ICUs) requires adjustment for patient variables. Severity of illness scores are associated with hospital mortality, but administrative databases rarely include the elements of these scores. However, these databases include the elements of comorbidity scores. The purpose of this study was to compare the value of these scores as adjustment variables in statistical models of hospital mortality and hospital and ICU length of stay after adjustment for other covariates.
We used multivariable regression to study 1808 patients admitted to a 13-bed medical-surgical ICU in a 400-bed tertiary hospital between December 1998 and August 2003.
For all patients, after adjusting for age, sex, major clinical category, source of admission, and socioeconomic determinants of health, we found that Acute Physiology and Chronic Health Evaluation (APACHE) II and comorbidity scores were significantly associated with hospital mortality and that comorbidity but not APACHE II was significantly associated with hospital length of stay. Separate analysis of hospital survivors and nonsurvivors showed that both APACHE II and comorbidity scores were significantly associated with hospital length of stay and APACHE II score was associated with ICU length of stay.
The value of APACHE II and comorbidity scores as adjustment variables depends on the outcome and population of interest.
PubMed ID
16769457 View in PubMed
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Canadian nurses' and respiratory therapists' perspectives on withdrawal of life support in the intensive care unit.

https://arctichealth.org/en/permalink/ahliterature173855
Source
J Crit Care. 2005 Mar;20(1):59-65
Publication Type
Article
Date
Mar-2005
Author
Graeme M Rocker
Deborah J Cook
Christopher J O'Callaghan
Deborah Pichora
Peter M Dodek
Wendy Conrad
Demetrios J Kutsogiannis
Daren K Heyland
Author Affiliation
Department of Medicine, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia. gmrocker@dal.ca
Source
J Crit Care. 2005 Mar;20(1):59-65
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Attitude to Death
Canada
Continuity of Patient Care
Decision Making
Euthanasia, Passive
Health Facility Environment
Humans
Intensive Care Units
Interdisciplinary Communication
Life Support Care
Nurses
Physicians
Respiratory Therapy
Terminal Care
Withholding Treatment
Abstract
To describe perspectives of nurses (RNs) and respiratory therapists (RTs) related to end-of-life care for critically ill patients.
For patients who had life support withdrawn in 4 Canadian university-affiliated ICUs, RNs and RTs reported their comfort level with decision making and process for 14 aspects of end-of-life care.
Ninety-eight patients had life support withdrawn. Responses were received from 96 (98.0%) bedside RNs and 73 (74.5%) RTs. Most RNs (85/94, 90.4%) and RTs (50/73, 68.5%) were very comfortable with decisions to withhold cardiopulmonary resuscitation or to withdraw life support (83/94, 88.3% of RNs and 56/73, 76.7% of RTs). Most RNs (range 71.3%-80.65%) and RTs (60.0%-70.8%) were very comfortable with ventilation/oxygen withdrawal and sedation. Among paired responses for 72 (73.5%) of 98 patients, RTs rated less favorably than RNs ( P
PubMed ID
16015517 View in PubMed
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Decision-making in the ICU: perspectives of the substitute decision-maker.

https://arctichealth.org/en/permalink/ahliterature187017
Source
Intensive Care Med. 2003 Jan;29(1):75-82
Publication Type
Article
Date
Jan-2003
Author
Daren K Heyland
Deborah J Cook
Graeme M Rocker
Peter M Dodek
Demetrios J Kutsogiannis
Sharon Peters
Joan E Tranmer
Christopher J O'Callaghan
Author Affiliation
Department of Medicine, Angada 3, Kingston General Hospital, Ontario, Canada. dkh2@post.queensu.ca
Source
Intensive Care Med. 2003 Jan;29(1):75-82
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Canada
Consumer Satisfaction
Decision Making
Family
Female
Humans
Intensive Care Units
Life Support Care
Logistic Models
Male
Middle Aged
Multivariate Analysis
Professional-Family Relations
Prospective Studies
Abstract
To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making.
Prospective, multicenter, cohort study.
Six Canadian university-affiliated ICUs.
We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h.
None.
A group consisting of 1,123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared decision-making process. Factors contributing the most to satisfaction with decision-making included: complete satisfaction with level of health care the patient received, completeness of information received, and feeling supported through the decision-making process. Satisfaction with decision-making varied significantly across sites.
In this multicenter observational study, we found that most substitute decision-makers for ICU patients wanted to share decision-making responsibility with physicians and that, overall, they were satisfied with their decision-making experience. Adequate communication, feeling supported, and achieving the appropriate level of care for their family member were key determinants of satisfaction with decision-making in the ICU.
PubMed ID
12528026 View in PubMed
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Defining priorities for improving end-of-life care in Canada.

https://arctichealth.org/en/permalink/ahliterature140279
Source
CMAJ. 2010 Nov 9;182(16):E747-52
Publication Type
Article
Date
Nov-9-2010
Author
Daren K Heyland
Deborah J Cook
Graeme M Rocker
Peter M Dodek
Demetrios J Kutsogiannis
Yoanna Skrobik
Xuran Jiang
Andrew G Day
S Robin Cohen
Author Affiliation
Department of Medicine, Kingston General Hospital, Kingston, Ont. dkh2@queensu.ca
Source
CMAJ. 2010 Nov 9;182(16):E747-52
Date
Nov-9-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude to Death
Canada
Caregivers - psychology
Cross-Sectional Studies
Female
Hospice Care - methods
Humans
Male
Palliative Care - methods - psychology
Patient Preference
Patient satisfaction
Professional-Family Relations
Quality of Life
Questionnaires
Terminal Care - methods - psychology
Terminally Ill - psychology
Total Quality Management
Abstract
High-quality end-of-life care should be the right of every Canadian. The objective of this study was to identify aspects of end-of-life care that are high in priority as targets for improvement using feedback elicited from patients and their families.
We conducted a multicentre, cross-sectional survey involving patients with advanced, life-limiting illnesses and their family caregivers. We administered the Canadian Health Care Evaluation Project (CANHELP) questionnaire along with a global rating question to measure satisfaction with end-of-life care. We derived the relative importance of individual questions on the CANHELP questionnaire from their association with a global rating of satisfaction, as determined using Pearson correlation coefficients. To determine high-priority issues, we identified questions that had scores indicating high importance and low satisfaction.
We approached 471 patients and 255 family members, of whom 363 patients and 193 family members participated, with response rates of 77% for patients and 76% for families. From the perspective of patients, high-priority areas needing improvement were related to feelings of peace, to assessment and treatment of emotional problems, to physician availability and to satisfaction that the physician took a personal interest in them, communicated clearly and consistently, and listened. From the perspective of family members, similar areas were identified as high in priority, along with the additional areas of timely information about the patient's condition and discussions with the doctor about final location of care and use of end-of-life technology.
End-of-life care in Canada may be improved for patients and their families by providing better psychological and spiritual support, better planning of care and enhanced relationships with physicians, especially in aspects related to communication and decision-making.
Notes
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PubMed ID
20921249 View in PubMed
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The development and validation of a novel questionnaire to measure patient and family satisfaction with end-of-life care: the Canadian Health Care Evaluation Project (CANHELP) Questionnaire.

https://arctichealth.org/en/permalink/ahliterature142369
Source
Palliat Med. 2010 Oct;24(7):682-95
Publication Type
Article
Date
Oct-2010
Author
Daren K Heyland
Deborah J Cook
Graeme M Rocker
Peter M Dodek
Demetrios J Kutsogiannis
Yoanna Skrobik
Xuran Jiang
Andrew G Day
S Robin Cohen
Author Affiliation
Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada. dkh2@queensu.ca
Source
Palliat Med. 2010 Oct;24(7):682-95
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Canada
Caregivers - psychology
Epidemiologic Methods
Female
Health Care Surveys
Humans
Male
Middle Aged
Palliative Care - psychology - standards
Patient satisfaction
Quality of Life - psychology
Research Design
Terminal Care - psychology - standards
Terminally ill
Abstract
The purpose of this study was to further validate a novel instrument to measure satisfaction with end-of-life care, called the Canadian Health Care Evaluation Project (CANHELP) questionnaire. Data were collected by a cross-sectional survey of patients who had advanced, life-limiting illnesses and their family caregivers, and who completed CANHELP, a global rating of satisfaction, and a quality of life questionnaire. We conducted factor analysis, assessed internal consistency using Cronbach's alpha, and evaluated construct validity by describing the correlation amongst CANHELP, global rating of satisfaction and the quality of life questionnaire scores. There were 361 patient and 193 family questionnaires available for analysis. In the factor analysis, we identified six easily interpretable factors which explained 55.4% and 60.2% of the variance for the patient and caregiver questionnaire, respectively. For the patient version, the subscales derived from these factors were Relationship with Doctors, Illness Management, Communication, Decision-Making, Role of the Family, and Your Well-being. For the family questionnaire, the factors were Relationship with Doctors, Characteristics of Doctors and Nurses, Illness Management, Communication and Decision-Making, Your Involvement, and Your Well-being. Each subscale for each questionnaire had acceptable to excellent internal consistency (Cronbach's alpha ranged from 0.69-0.94). We observed good correlations between the CANHELP overall satisfaction score and global rating of satisfaction (correlation coefficient 0.49 and 0.63 for patient and family, respectively) which was greater than the correlations between CANHELP and the quality of life instruments. We conclude that the CANHELP Questionnaire is a valid and internally consistent instrument to measure satisfaction with end-of-life care.
PubMed ID
20605850 View in PubMed
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Differences in hospital mortality among critically ill patients of Asian, Native Indian, and European descent.

https://arctichealth.org/en/permalink/ahliterature155764
Source
Chest. 2008 Dec;134(6):1217-22
Publication Type
Article
Date
Dec-2008
Author
Nadia A Khan
Anita Palepu
Monica Norena
Najib Ayas
Hubert Wong
Dean Chittock
Morad Hameed
Peter M Dodek
Author Affiliation
Department of Medicine, Centre for Health Evaluation and Outcome Sciences, University of British Columbia, BC, Canada. nakhan@shaw.ca
Source
Chest. 2008 Dec;134(6):1217-22
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Asian Continental Ancestry Group - statistics & numerical data
Brain Injuries - ethnology - mortality
British Columbia - epidemiology
Cohort Studies
Critical Illness
European Continental Ancestry Group - statistics & numerical data
Female
Hospital Mortality - ethnology
Humans
Indians, North American - statistics & numerical data
Lung Diseases - ethnology - mortality
Male
Middle Aged
Sepsis - ethnology - mortality
Abstract
It is unclear whether race/ethnicity influences survival for acute critical illnesses. We compared hospital mortality among patients of Asian (originating from Asia or Southeast Asia), Native Indian, and European descent admitted to the ICU.
Prospective cohort study of patients admitted to three ICUs (January 1999 to January 2006) in British Columbia, Canada. Multivariable analysis evaluated hospital mortality for each ethnic group, adjusting for age, sex, APACHE (acute physiology and chronic health evaluation) II score, hospital, median income, unemployment, and education. To account for differences in case mix, multivariable analysis was also restricted to those patients admitted for the five most common ICU admission diagnoses (sepsis, pneumonia, brain injury, COPD, and ARDS) and adjusted for these diagnoses.
Of 7,331 patients, 21% were Asian, 4% were Native Indian, and 75% were of European descent. Crude mortality was 33% for Asian, 30% for Native Indians, and 28% for patients of European descent. After adjusting for potential confounders, Native Indian descent was not associated with an increase in mortality compared to European descent. Asian descent was associated with a significantly higher mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06 to 1.41; p = 0.005). After adjusting for case mix, this difference was no longer seen. For patients admitted for COPD exacerbation, Asian descent was associated with a substantial increase in mortality (OR, 4.5; 95% CI, 1.56 to 12.9; p = 0.005). There were no significant differences in mortality by race/ethnicity for patients who had any of the other common admitting diagnoses.
Patients of Asian and Native Indian descent with acute critical illness did not have an increased mortality after adjusting for differences in case mix.
PubMed ID
18689577 View in PubMed
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DNR directives are established early in mechanically ventilated intensive care unit patients.

https://arctichealth.org/en/permalink/ahliterature74898
Source
Can J Anaesth. 2004 Dec;51(10):1034-41
Publication Type
Article
Date
Dec-2004
Author
Tasnim Sinuff
Deborah J Cook
Graeme M Rocker
Lauren E Griffith
Stephen D Walter
Malcolm M Fisher
Peter M Dodek
Peter Sjokvist
Ellen McDonald
John C Marshall
Peter A Kraus
Mitchell M Levy
Neil M Lazar
Gordon H Guyatt
Author Affiliation
Department of Medicine, McMaster University Health Sciences Center, Room 2C11, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
Source
Can J Anaesth. 2004 Dec;51(10):1034-41
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
APACHE
Advance Directives - statistics & numerical data
Aged
Australia
Canada
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Outcome Assessment (Health Care)
Research Support, Non-U.S. Gov't
Respiration, Artificial - statistics & numerical data
Resuscitation Orders
Sweden
Time Factors
United States
Withholding Treatment - statistics & numerical data
Abstract
PURPOSE: Setting treatment goals in the intensive care unit (ICU) often involves resuscitation decisions. Our objective was to study the rate of establishing do-not-resuscitate (DNR) directives, determinants, and outcomes of those directives for mechanically ventilated patients. METHODS: In a multicentre observational study, we included consecutive adults with no DNR directives within 24 hr of ICU admission who were mechanically ventilated for at least 48 hr. We identified the rate with which DNR directives were established, and factors associated with these directives. RESULTS: Among 765 patients, DNR directives were established for 231 (30.2%) patients; 143 (62.1%) of these were established within the first week. Factors independently associated with a DNR directive were: patient age [> or = 75 yr (hazard ratio [HR] 2.3, 95% confidence interval 1.5-3.4], 65 to 74 yr (HR 1.8, 1.2-2.7), 50 to 64 yr (HR 1.4, 1.0-2.2) relative to 90%]; and physician perception of patient preference to limit life support (no advanced life support [(HR 5.8, 3.6-9.4) or partial advanced life support (HR 3.2, 2.2-4.6) compared to full measures]. CONCLUSION: One third of mechanically ventilated patients had DNR directives established early during their ICU stay after the first 24 hr of admission. The strongest predictors of DNR directives were physician prediction of low probability of survival, physician perception of patient preference to limit life support, organ dysfunction, medical diagnosis and age.
PubMed ID
15574557 View in PubMed
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Explicit approach to rounds in an ICU improves communication and satisfaction of providers.

https://arctichealth.org/en/permalink/ahliterature184201
Source
Intensive Care Med. 2003 Sep;29(9):1584-8
Publication Type
Article
Date
Sep-2003
Author
Peter M Dodek
Janet Raboud
Author Affiliation
Program in Critical Care Medicine, St. Paul's Hospital and University of British Columbia, 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada. pedodek@interchange.ubc.ca
Source
Intensive Care Med. 2003 Sep;29(9):1584-8
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
British Columbia
Health Care Surveys
Humans
Institutional Practice - organization & administration
Intensive Care Units - organization & administration
Internship and Residency - organization & administration
Interprofessional Relations
Job Satisfaction
Medical Staff, Hospital - organization & administration
Nursing Staff, Hospital - organization & administration
Organizational Culture
Respiratory Therapy Department, Hospital - organization & administration
Abstract
To evaluate an explicit approach to responsibilities and reporting during bedside rounds in the intensive care unit (ICU).
Before-after comparison in the 15-bed medical-surgical ICU in a tertiary teaching hospital.
All patients in the ICU during two 1-month periods: 2 months before and 16 months after the intervention.
Explicit approach to clinical and educational responsibilities and to reporting assessments and plans during bedside rounds.
Surveys of all ICU staff (attending physicians, residents, nurses, respiratory therapists, pharmacists, and medical students) were conducted during rounds on each patient. After the intervention, more respondents agreed that there was a long-term plan for each patient (74% vs. 53% before), that the long-term plan was clear (76% vs. 54% before), that there was structured teaching around each patient (46% vs. 30% before), that discussions other than structured teaching around each patient were useful (79% vs. 65% before), and that they were satisfied with the process and outcome of rounds (95% vs. 86% before). In contrast, slightly fewer respondents were aware of a problem list for the patients (96% vs. 99% before), and fewer residents and medical students had examined their patients before rounds (76% vs. 88% before).
An explicit approach to bedside rounds in an ICU improves communication and satisfaction of health care providers.
PubMed ID
12898001 View in PubMed
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Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study.

https://arctichealth.org/en/permalink/ahliterature118301
Source
Crit Care Med. 2013 Jan;41(1):15-23
Publication Type
Article
Date
Jan-2013
Author
Tasnim Sinuff
John Muscedere
Deborah J Cook
Peter M Dodek
William Anderson
Sean P Keenan
Gordon Wood
Richard Tan
Marilyn T Haupt
Michael Miletin
Redouane Bouali
Xuran Jiang
Andrew G Day
Janet Overvelde
Daren K Heyland
Author Affiliation
Sunnybrook Research Institute, Sunnybrook Health Sciences Center and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. taz.sinuff@sunnybrook.ca
Source
Crit Care Med. 2013 Jan;41(1):15-23
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Canada
Female
Guideline Adherence
Humans
Inservice training
Male
Middle Aged
Outcome Assessment (Health Care)
Pneumonia, Ventilator-Associated - diagnosis - prevention & control - therapy
Practice Guidelines as Topic
Prospective Studies
Translational Medical Research
United States
Abstract
Ventilator-associated pneumonia is an important cause of morbidity and mortality in critically ill patients. Evidence-based clinical practice guidelines for the prevention, diagnosis, and treatment of ventilator-associated pneumonia may improve outcomes, but optimal methods to ensure implementation of guidelines in the intensive care unit are unclear. Hence, we determined the effect of educational sessions augmented with reminders, and led by local opinion leaders, as strategies to implement evidence-based ventilator-associated pneumonia guidelines on guideline concordance and ventilator-associated pneumonia rates.
Two-year prospective, multicenter, time-series study conducted between June 2007 and December 2009.
Eleven ICUs (ten in Canada, one in the United States); five academic and six community ICUs.
At each site, 30 adult patients mechanically ventilated >48 hrs were enrolled during four data collection periods (baseline, 6, 15, and 24 months).
Guideline recommendations for the prevention, diagnosis, and treatment of ventilator-associated pneumonia were implemented using a multifaceted intervention (education, reminders, local opinion leaders, and implementation teams) directed toward the entire multidisciplinary ICU team. Clinician exposure to the intervention was assessed at 6, 15, and 24 months after the introduction of this intervention.
The main outcome measure was aggregate concordance with the 14 ventilator-associated pneumonia guideline recommendations. One thousand three hundred twenty patients were enrolled (330 in each study period). Clinician exposure to the multifaceted intervention was high and increased during the study: 86.7%, 93.3%, 95.8%, (p
Notes
Comment In: Crit Care Med. 2013 Jan;41(1):329-3123269134
PubMed ID
23222254 View in PubMed
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In-hospital death of critically ill patients who have congestive heart failure: does size of hospital matter?

https://arctichealth.org/en/permalink/ahliterature145492
Source
Am J Med Qual. 2010 Mar-Apr;25(2):95-101
Publication Type
Article
Author
Janet Dubord
Peter M Dodek
Keith Chan
Sean P Keenan
Stephen Marion
Hubert Wong
Author Affiliation
St. Paul's Hospital, University of British Columbia,Vancouver, BC, Canada.
Source
Am J Med Qual. 2010 Mar-Apr;25(2):95-101
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
British Columbia - epidemiology
Cohort Studies
Critical Illness - mortality
Databases as Topic
Female
Heart Failure - mortality
Hospital Bed Capacity
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Abstract
Data from the British Columbia Linked Health Database were analyzed to determine if size of hospital is associated with in-hospital death of critically ill adults whose admitting diagnosis is congestive heart failure (CHF). Patients who were
PubMed ID
20145195 View in PubMed
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19 records – page 1 of 2.