Clinical trial NCT01323816: Differences in Care Provided in Intensive Care Units (ICUs) With Physician Versus Nurse Practitioner First Responders
Official title: Process and Outcome Differences in Care Provided in Intensive Care Units (ICUs) With Physician Versus Nurse Practitioner First Responders
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Critical Illness
Lead sponsor: Ohio State University
Sponsor class: OTHER
First posted: 2011-03-28
Enrollment: 3659
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Any patients being seen at designated ICU during the time period being investigated.

Brief summary: 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: 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.

Eligibility criteria: Inclusion Criteria:

* Patients admitted to designated ICU between September 1, 2007 and September 30, 2010.

Exclusion Criteria:

* Not admitted to designated ICU.

Primary outcomes:
measure: Life-years hospital costs
timeFrame: 2007 - 2010
Secondary outcomes:
measure: Intensive Care Unit (ICU) mortality
timeFrame: 2007 - 2010
measure: Hospital mortality
timeFrame: 2007 - 2010
measure: Time to death
timeFrame: 2007 - 2010
measure: Ventilator Days
timeFrame: 2007 - 2010
measure: Ventilator-free days
timeFrame: 2007 - 2010
measure: Intensive Care Unit (ICU)-free days
timeFrame: 2007 - 2010
measure: Evidence-based care
timeFrame: 2007 - 2010
measure: Discharge location among survivors
timeFrame: 2007 - 2010
measure: Intensive Care Unit (ICU)Length of Stay (LOS)
timeFrame: 2007 - 2010
measure: Hospital Length of Stay (LOS)
timeFrame: 2007 - 2010
measure: Hospital costs
timeFrame: 2007 - 2010
measure: Hospital charges
timeFrame: 2007 - 2010
measure: Patient Satisfaction Survey Results
timeFrame: 2007 - 2010
Other outcomes:
Locations:
city: Columbus
country: United States
facility: The Ohio State University
state: Ohio
Study officials:
affiliation: Ohio State University
name: Naeem Ali, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Cooper LM, Linde-Zwirble WT. Medicare intensive care unit use: analysis of incidence, cost, and payment. Crit Care Med. 2004 Nov;32(11):2247-53. doi: 10.1097/01.ccm.0000146301.47334.bd.
citation: Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med. 2004 Jun;32(6):1254-9. doi: 10.1097/01.ccm.0000128577.31689.4c.
citation: Kleinpell RM, Ely EW, Grabenkort R. Nurse practitioners and physician assistants in the intensive care unit: an evidence-based review. Crit Care Med. 2008 Oct;36(10):2888-97. doi: 10.1097/CCM.0b013e318186ba8c.
citation: Mitchell-DiCenso A, Guyatt G, Marrin M, Goeree R, Willan A, Southwell D, Hewson S, Paes B, Rosenbaum P, Hunsberger M, Baumann A. A controlled trial of nurse practitioners in neonatal intensive care. Pediatrics. 1996 Dec;98(6 Pt 1):1143-8.
citation: Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002 Nov 6;288(17):2151-62. doi: 10.1001/jama.288.17.2151.
citation: Treggiari MM, Martin DP, Yanez ND, Caldwell E, Hudson LD, Rubenfeld GD. Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury. Am J Respir Crit Care Med. 2007 Oct 1;176(7):685-90. doi: 10.1164/rccm.200701-165OC. Epub 2007 Jun 7.