Differences in Care Provided in Intensive Care Units (ICUs) With Physician Versus Nurse Practitioner First Responders

Study Overview
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Brief Summary
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The purpose of this study is to evaluate and compare outcomes of patients that have received care in medical intensive care units in a tertiary care facility with two different models; the traditional model including resident, pulmonary fellow and attending physician and a nontraditional model which has Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending.

Detailed Description
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This will be a retrospective cohort study that is performed between two medical intensive care units (ICU). The goal is to compare outcomes of patients that have received care in medical intensive care units in a tertiary care facility with two different models; the traditional model including a resident, pulmonary fellow and attending and a nontraditional model which has Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending. Outcomes that will be measured include ICU length of stay, hospital length of stay after ICU discharge, ventilator days, daily spontaneous breathing trials, and daily awakening trials, as well as mortality in hospital and after discharge.

Official Title
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Process and Outcome Differences in Care Provided in Intensive Care Units (ICUs) With Physician Versus Nurse Practitioner First Responders

Conditions
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Critical Illness

Intervention / Treatment
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* Other: Medically directed care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted to designated ICU between September 1, 2007 and September 30, 2010. Exclusion Criteria: Not admitted to designated ICU.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Traditional<br>ICU staffed by a resident, pulmonary fellow and attending | Other: Medically directed care<br>* There is no research directed care. Patients are treated as medically indicated.<br>|
| Non-Traditional<br>ICU staffed by Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending | Other: Medically directed care<br>* There is no research directed care. Patients are treated as medically indicated.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Life-years hospital costs | Life-years per $10,000 hospital costs - defined as the sum of days of survival after ICU admission for all patients admitted to each ICU/sum of all hospital costs for all patients admitted to each ICU | 2007 - 2010 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intensive Care Unit (ICU) mortality |  | 2007 - 2010 | 
| Hospital mortality |  | 2007 - 2010 | 
| Time to death |  | 2007 - 2010 | 
| Ventilator Days |  | 2007 - 2010 | 
| Ventilator-free days | Days alive and not requiring mechanical ventilation in first 28 days after ICU admission | 2007 - 2010 | 
| Intensive Care Unit (ICU)-free days | Days alive and not in the ICU in first 28 days after ICU admission | 2007 - 2010 | 
| Evidence-based care | % of ICU days receiving evidence-based care will also be explored as mediators of other outcomes) Sedation holidays Spontaneous breathing trials Days with continuous infusions of sedatives Head of bed elevation | 2007 - 2010 | 
| Discharge location among survivors |  | 2007 - 2010 | 
| Intensive Care Unit (ICU)Length of Stay (LOS) |  | 2007 - 2010 | 
| Hospital Length of Stay (LOS) |  | 2007 - 2010 | 
| Hospital costs |  | 2007 - 2010 | 
| Hospital charges |  | 2007 - 2010 | 
| Patient Satisfaction Survey Results |  | 2007 - 2010 |