A two-compartment mixed-effects gamma regression model for quantifying between-unit variability in length of stay among children admitted to intensive care

Straney, Lahn, Clements, Archie, Alexander, Jan, Slater, Anthony and ANZICS Paediatric Study Group (2012) A two-compartment mixed-effects gamma regression model for quantifying between-unit variability in length of stay among children admitted to intensive care. Health Services Research, 47 6: 2190-2203. doi:10.1111/j.1475-6773.2012.01421.x

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Author Straney, Lahn
Clements, Archie
Alexander, Jan
Slater, Anthony
ANZICS Paediatric Study Group
Total Author Count Override 4
Title A two-compartment mixed-effects gamma regression model for quantifying between-unit variability in length of stay among children admitted to intensive care
Journal name Health Services Research   Check publisher's open access policy
ISSN 0017-9124
1475-6773
Publication date 2012-12-01
Sub-type Article (original research)
DOI 10.1111/j.1475-6773.2012.01421.x
Volume 47
Issue 6
Start page 2190
End page 2203
Total pages 14
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell
Collection year 2013
Language eng
Formatted abstract
Objective: To quantify between-unit variability in mean length of stay (LoS) between intensive care units (ICUs) after adjusting for differences in case mix using a method that does not require arbitrary trimming of data.

Setting: An analysis of registry data from pediatric ICUs (PICUs) in Australia and New Zealand.

Study Design: The relationships between patient LoS and associated patient factors were modeled as a log-linear function of the covariates using two gamma distributions. The predicted distribution is estimated as a weighted average of the two distributions where the relative weighting is conditional on the patient's elective status.

Data Collection Data:
for 12,763 admissions submitted to the Australian and New Zealand Paediatric Intensive Care Registry from the eight dedicated PICUs in Australia and New Zealand in 2007 and 2008.

Principal Findings: The two distributions of the mixture model accurately described the distribution of short- and long-stay patients in ICUs. After adjusting for patient case mix, several sites had a statistically significant effect on patient LoS.

Conclusion: The two-compartment model characterizes ICU LoS for short- and long-stay patients more effectively than a single-compartment model. There is significant site-level variation in the LoS among children admitted to ICUs in Australia and New Zealand. Differences in the site-level variation between short- and long-stay patients indicate differences in discharge practice.
Keyword Quality indicators
Pediatrics
Length of stay
Intensive care
Risk adjustment
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 17 May 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Agriculture and Food Sciences
Official 2013 Collection
School of Public Health Publications
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
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