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Measuring resource use in the ICU with computerized therapeutic intervention scoring system-based data

Clermont, G and Angus, DC and Linde-Zwirble, WT and Lave, JR and Pinsky, MR (1998) Measuring resource use in the ICU with computerized therapeutic intervention scoring system-based data. Chest, 113 (2). 434 - 442. ISSN 0012-3692

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Background and objective: In this era of healthy-care reform, there is increasing need to monitor and control health-care resource consumption. This requires the development of measurement tools that are practical, uniform, reproducible, and of sufficient detail to allow comparison among institutions, among select groups of patients, and among individual patients. We explored the feasibility of generating an index of resource use based on the Therapeutic Intervention Scoring System (TISS) from hospital electronic billing data. Such an index is potentially comparable across institutions, allows assessment of care at many levels, is well understood by clinicians, and captures many of the resources relevant to the ICU. Design: We developed an automated mapping of the hospital billing database into the different items of TISS and generated computerized active TISS scores on 1,372 ICU days. The computerized score was then validated by comparison to prospectively gathered active TISS scores by trained data collectors. Setting: Eight ICUs within a university teaching institution. Patients: We studied 1,229 general medical and surgical ICU patients. Interventions: None. Measurements and main results: Active TISS scores ranged from 0 to 31 points. The two scores were well correlated (R2 = 0.53) and highly calibrated (as assessed by regression of active TISS on mean computerized active TISS [R2 = 0.85]). The scores were identical on 756 days (55.6%) and differed by ≤3 TISS points on an additional 387. (28.2%) days. Interreliability assessment suggested substantial agreement (kappa statistic = 0.71). The discriminatory power of the computerized score to identify different levels of ICU resource use was excellent as assessed by area under the receiver operating characteristics curves at four threshold points (.91, 0.87, 0.89, and 0.88). Performance of the computerized score was similar across medical, coronary, and surgical ICU patient groups. Conclusion: An automated algorithm can reproduce valid TISS scores from standard hospital billing data, allowing comparison of patients and groups of patients in order to better understand ICU resource use.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Clermont, Gcler@pitt.eduCLER0000-0002-0163-1379
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Linde-Zwirble, WT
Lave, JRlave@pitt.eduLAVE
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 January 1998
Date Type: Publication
Journal or Publication Title: Chest
Volume: 113
Number: 2
Page Range: 434 - 442
DOI or Unique Handle: 10.1378/chest.113.2.434
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0012-3692
PubMed ID: 9498964
Date Deposited: 13 Mar 2012 15:46
Last Modified: 22 Jun 2021 11:55


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