A COMPARISON OF INTENSIVE-CARE UNIT UTILIZATION IN ALBERTA AND WESTERN MASSACHUSETTS

Objective: To analyze differences in intensive care unit (ICU) utiliza tion between a Canadian province and a U.S. area. Design: Retrospectiv e data analysis of hospital discharge data and existing data from an i nternational study of severity of illness in ICU patients. Setting: Ad ministrative data for the province of Alberta and the four counties of western Massachusetts for the years 1990 to 1991 were used, Detailed data on consecutive ICU admissions from two Alberta hospitals, one wes tern Massachusetts hospital, and 24 other U.S. hospitals for 3 months in 1991 were used. Measurements and Main Results: ICU use and hospital mortality rates were compared for 50,030 hospital admissions divided into 11 patient groups. ICU days per million population were two to th ree times as great in western Massachusetts as in Alberta. The primary reason was higher ICU incidence (percent of hospitalized patients tre ated in the ICU) rather than a difference in hospital admission rate o r length of ICU stay, ICU incidence in western Massachusetts was signi ficantly higher in ten of 11 patient groups-for the coronary bypass su rgery group, there was no difference. The hospital mortality rate in w estern Massachusetts was similar to, or higher than, the mortality rat e in Alberta, In Alberta, a much higher proportion of ICU patients rec eived mechanical ventilation. For elective surgery patients, the ICU s everity of illness was lower in western Massachusetts and in other U.S . hospitals than in Alberta. Conclusions: Western Massachusetts hospit alized patients are more likely to be treated in an ICU than are simil ar patients in Alberta. There is no evidence that the greater ICU util ization in western Massachusetts led to a lower hospital mortality rat e.