All ETDs from UAB

Advisory Committee Chair

Robert W Maldonado

Advisory Committee Members

Larry R Hearld

Stephen J O'Connor

Patricia A Patrician

Bisakha Sen

Document Type

Dissertation

Date of Award

2015

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

Because of the high intensity of care and the extremely complex medical conditions being treated, intensive care units (ICUs) represent one of the most significant units within a hospital. Despite the significance of the ICU, the majority of the care provided in the ICU has historically been managed and coordinated by referring or attending physicians, who often do not have the specialized training needed to effectively care for the exceedingly acute patients in the ICU. More recently, however, a growing number of hospitals have begun staffing the ICU with intensivists. Intensivists are uniquely trained physicians that specialize in providing care in hospital ICUs. Early studies have shown staffing the ICU with intensivists is associated with improved outcomes such as lower mortality rates, lower lengths of stay and reduced costs. Most of these studies, however, have been cross-sectional in design or have focused a single teaching facility or on a single diagnoses or procedure. In addition, no study has explored the environmental and market factors associated with the use of intensivists. The purpose of this study is to provide insight into the environmental and market factors associated with the use of intensivists and to broaden the scope and generalizability of knowledge regarding the benefits of utilizing intensivists. This study found that larger, system affiliated hospitals located in markets with higher per capita income and higher percentages of specialists are more likely to utilize intensivists. In addition, the study found that the use of intensivists is associated with lower average cost per patient day for patients with a principal diagnosis of acute myocardial infarction (AMI). This study also found that the association between the intensivist staffing and the average cost per patient day is nonlinear. Through ad hoc analysis, it was discovered that only the lowest and highest levels of intensivist staffing intensity were associated with lower cost per patient day. Finally this study found that the use of intensivists was associated with a reduction in AMI mortality rates and a decline in the occurrence rate of both pressure ulcers and perioperative hemorrhaging or hematoma for ICU patients.

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