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Variation in critical care services across North America and Western Europe*

Wunsch, Hannah MD, MSc; Angus, Derek C. MD, MPH; Harrison, David A. PhD; Collange, Olivier MD; Fowler, Robert MD; Hoste, Eric A. J. MD; de Keizer, Nicolette F. PhD; Kersten, Alexander MD; Linde-Zwirble, Walter T.; Sandiumenge, Alberto MD; Rowan, Kathryn M. PhD

doi: 10.1097/CCM.0b013e318186aec8
Clinical Investigations

Objective: Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in eight countries.

Design: Retrospective review of existing national administrative data. We identified sources of data in each country to provide information on acute care hospitals and beds, intensive care units and beds, intensive care admissions, and definitions of intensive care beds. Data were all referenced and from as close to 2005 as possible.

Setting: United States, France, United Kingdom, Canada, Belgium, Germany, The Netherlands, and Spain.

Patients: Not available.

Interventions: None.

Measurements and Main Results: No standard definition existed for acute care hospital or intensive care unit beds across countries. Hospital beds varied three-fold from 221/100,000 population in the United States to 593/100,000 in Germany. Adult intensive care unit beds also ranged seven-fold from 3.3/100,000 population in the United Kingdom to 24.0/100,000 in Germany. Volume of intensive care unit admissions per year varied ten-fold from 216/100,000 population in the United Kingdom to 2353/100,000 in Germany. The ratio of intensive care unit beds to hospital beds was highly correlated across all countries except the United States (r = .90). There was minimal correlation between the number of intensive care unit beds per capita and health care spending per capita (r = .45), but high inverse correlation between intensive care unit beds and hospital mortality for intensive care unit patients across countries (r = −.82).

Conclusions: Absolute critical care services vary dramatically between countries with wide differences in both numbers of beds and volume of admissions. The number of intensive care unit beds per capita is not strongly correlated with overall health expenditure, but does correlate strongly with mortality. These findings demonstrate the need for critical care data from all countries, as they are essential for interpretation of studies, and policy decisions regarding critical care services.

From the Department of Anesthesiology (HW), Columbia University, New York, NY; Department of Critical Care (DCA), University of Pittsburgh, Pittsburgh, PA; Intensive Care National Audit and Research Centre (DAH, KMR), London, United Kingdom; Anesthésie - Réanimation chirurgicale (OC), Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Department of Medicine and Critical Care Medicine (RF), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Intensive Care Medicine (EAJH), Ghent University Hospital, Ghent, Belgium; Department of Medical Informatics (NFK), Academic Medical Center, Universiteit van Amsterdam/ NICE Foundation, The Netherlands; Medizinische Klinik I (AK), Universitätsklinikum RWTH Aachen, Germany; ZD Associates (WTL-Z), Perkasie, PA; and Intensive Care Department (AS), University Hospital Joan XXIII, Tarragona, Spain.

Institutions where work was performed: Columbia University, and Intensive Care National Audit and Research Centre.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: hw2125@columbia.edu

Online supplementary data can be viewed at http://www.ccmjournal.org.

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins