The ETHICA Study (Part II): Simulation Study of Determinants and Variability of ICU Physician Decisions in Patients Aged 80 or Over.
M GARROUSTE-ORGEAS, MD; A TABAH, MD;A VESIN, MSc; JF TIMSIT, MD, PhD; A KPODJI, MD; C BRUEL, MD; F PHILIPPART, MD, PhD; B MISSET, MD; on behalf of the ETHICA group.
Corresponding author and requests for reprints: Maité Garrouste-Orgeas, Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, FRANCE
Tel: +33 144 123 415; Fax: +33 144 123 280
E-mail:
ONLINE DATA SUPPLEMENT
Summary
Resource 1. Characteristics of the hospitals and intensivePage 3
care units (ICUs) of the participating physicians
Resource 2. Characteristics of the 100 participating physiciansPage 4
Resource 3.Questions exploring physician decisionsPage 5
Resource 4. Determinants of decisions to use life-sustainingPages 6-8
Treatments (univariate analysis)
Resource 5. Determinants of decisions to use life-sustainingPages 9-13
Treatments after information about patient preferences
(univariate analysis).
ReferencesPage 14
1
Resource 1. Characteristics of the hospitals and intensive care units (ICUs) of the participating physicians
Hospitals (n=56)University hospital, n (%)
Number of hospital beds, median (IQR)
Existence of a geriatric unit, n (%)
In the Paris area, n (%) / Data
30 (53.6)
655 (467-1200)
43 (76.8)
26 (46.4)
ICU (n=63)
Medical, n (%)
Surgical, n, (%)
Mixed, n (%)
Other, n (%)
Number of acute beds per unit, median (IQR)
Number of intermediate beds per unit, median (IQR)
Number of attending physicians, median (IQR)
Number of junior physicians, median (IQR)
Day off after night duty for physicians*, n (%) / 18 (28.6)
9 (14.3)
33 (52.4)
3 (4.8)
12 (8-15)
4 (0-6)
6 (5-8)
4 (2-5)
51 (81)
ICU, intensive care unit; IQR, interquartile range
*day off after night duty, 11-hour period without clinical activities after night duty mandated by French law
1
Resource 2. Characteristics of the 100 participating physicians
Variables / DataAge, years ± SD / 40.6 ± 8.8
Females, n / 37
Job title in the ICU, n
Senior physician / 100
Religion, n
Catholic
Other
None / 17
6
77
Time working in ICUs, months, median (IQR) / 114 (46-186)
Time working in the study ICU, months, median (IQR) / 60 (19.5-132)
Number of night duties per month, n / 5 (4-5)
ICU, intensive care unit; IQR, interquartile range
Resource 3. Questions exploring physician decisions
Non-invasive ventilation (NIV)Number of beds available in your ICU at the time of your decision
Given the number of available beds, would you admit this patient to your ICU for NIV?
If you had an additional available bed, would you change your decision?
Invasive mechanical ventilation (IMV)
Number of beds available in your ICU at the time of your decision
Given the number of available beds, would you admit this patient to your ICU for IMV?
If you had an additional available bed, would you change your decision?
Renal replacement therapy after invasive mechanical ventilation (RRT after IMV)
Number of beds available in your ICU at the time of your decision
Given the number of available beds, would you initiate RRT in this patient in your ICU?
1
Resource 4. Determinants of decisions to use life-sustaining treatments (univariate analysis)
NIV / IMV / RRT after IMVPatient variables / Refused
N=57 / Accepted
N=343 / p value / Refused
N=88 / Accepted
N=312 / p value / Refused
N=151 / Accepted
N=249 / p value
Age, years, n, (%)
≤85
>85 / 21 (9.4)
36 (20.5) / 203 (90.6)
140 (79.5) / 0.004 / 34 (15.2)
54 (30.7) / 190 (84.8)
122 (69.3) / 0.002 / 59 (26.3)
92 (52.3) / 165 (73.7)
84 (47.7) / <0.0001
Gender
Female
Male / 40 (14.7)
17 (13.3) / 232 (85.3)
111 (86.7) / 0.5 / 60 (22.1)
28 (21.9) / 212 (77.9)
100 (78.1) / 0.6 / 112 (41.2)
39 (30.5) / 160 (58.8)
89 (69.5) / 0.08
Marital status, n, (%)
Single or widowed
Married or living with a partner / 48 (15.8)
9 (9.4) / 256 (84.2)
87 (90.6) / 0.15 / 75 (24.7)
13 (13.5) / 229 (75.3)
83 (86.5) / 0.051 / 122 (40.1)
29 (30.2) / 182 (59.9)
67 (69.8) / 0.13
Previous ICU admission, n, (%)
No
At least once / 42 (13.1)
15 (18.8) / 278 (86.9)
65 (81.3) / 0.22 / 63 (19.7)
25 (31.3) / 257 (80.3)
55 (68.8) / 0.1 / 111 (34.7)
40 (50) / 209 (65.3)
40 (50) / 0.04
Religious beliefs*, n
No
Yes / 0 (0)
57 (15.2) / 24 (100)
319 (84.8) / 1 (4.2)
87 (23.1) / 23 (95.8)
289 (76.9) / 0.065 / 1 (4.2)
150 (39.9) / 23 (95.8)
226 (60.1) / 0.01
Co-morbid conditions, n, (%)
Cardiac
No
Yes
Respiratory
No
Yes
Neurologic
No
Yes
Oncologic
No
Yes / 23 (12.8)
34 (15.5)
32 (12.7)
25 (16.9)
46 (14)
11 (15.3)
40 (13)
17 (18.5) / 157 (85.2)
186 (84.5)
220 (87.3)
123 (83.1)
282 (86)
61 (84.5)
268 (87)
61 (84.4) / 0.4
0.3
0.7
0.21 / 38 (21.1)
50 (22.7)
48 (19)
40 (27)
73 (22.3)
15 (20.8)
60 (19.5)
28 (30.4) / 142 (78.9)
170 (77.3)
204 (81)
108 (73)
255 (77.7)
57 (79.2)
248 (80.5)
64 (69.6) / 0.8
0.25
0.9
0.059 / 68 (37.8)
83 (37.7)
85 (33.7)
66 (44.6)
121 (36.9)
30 (41.7)
110 (35.7)
41 (44.6) / 112 (62.2)
137 (62.3)
167 (66.3)
82 (55.4)
207 (63.1)
42 (58.3)
198 (64.3)
51 (55.4) / 0.9
0.16
0.4
0.2
IADL score (restricted activities), n (%)
Full self-sufficiency (IADL=0)
Limited self-sufficiency (IADL 1 to 4) / 36 (11.1)
21 (27.6) / 288 (88.9)
55 (72.5) / 0.0013 / 53 (16.4)
35 (46.1) / 271 (83.6)
41 (53.9) / 0.0001 / 99 (30.6)
52 (68.4) / 225 (69.4)
24 (31.6) / <0.0001
ADL score, n, (%)
Full self-sufficiency (ADL=6)
Limited self-sufficiency, (ADL 0 to 5) / 35 (11.5)
22 (22.9) / 269 (88.5)
74 (77.1) / 0.015 / 54 (17.8)
34 (35.4) / 250 (82.2)
62 (64.6) / 0.008 / 99 (32.6)
52 (54.2) / 205 (67.4)
44 (45.8) / 0.006
Physician variables
Age, years±SD
<40
40 to 50
>50 / 22 (10.4)
27 (20.5)
8 (14.3) / 190 (89.6)
105 (79.5)
48 (85.7) / 0.2 / 48 (22.6)
29 (22)
11 (19.6) / 164 (77.4)
103 (78)
45 (80.4) / 0.9 / 80 (37.7)
48 (36.4)
23 (41.1) / 132 (62.3)
84 (63.6)
33 (58.9) / 0.7
Gender
Female
Male / 21(14.2)
36 (14.3) / 127(85.8)
216 (85.7) / 0.7 / 28 (18.9)
60 (23.8) / 120 (81.1)
192 (76.2) / 0.4 / 58 (39.2)
93 (36.9) / 90 (60.8)
159 (63.1) / 0.4
Religious beliefs, n
No
Yes / 40 (13.7)
17 (17.7) / 264 (86.8)
79 (82.3) / 0.4 / 66 (21.7)
22 (22.9) / 238 (78.3)
74 (77.1) / 0.7 / 117 (38.5)
34 (35.4) / 187 (61.5)
62 (64.6) / 0.7
Time working in ICUs
≤10 years
>10 years / 2 (10)
55 (15.5) / 18 (90)
325 (85.5) / 0.6 / 3 (15)
85 (22.4) / 17 (85)
295 (77.6) / 0.3 / 9 (45)
142 (37.4) / 11 (55)
238 (62.6) / 0.5
Time working in the study ICU
≤10 years
>10 years / 8 (11.1)
49 (14.9) / 64 (88.9)
279 (85.1) / 0.6 / 13 (18.1)
75 (22.9) / 59 (81.9)
253 (77.1) / 0.5 / 28 (38.9)
123 (37.5) / 44 (61.1)
205 (62.5) / 0.5
Number of duties per month
<4
4
5
≥5 / 15 (17.9)
12 (11.1)
16 (12.9)
14 (16.7) / 69 (82.1)
96 (88.9)
108 (87.1)
70 (83.3) / 0.5 / 16 (19)
26 (24.1)
25 (20.2)
21 (25) / 68 (81)
82 (75.9)
99 (79.8)
63 (75) / 0.9 / 32 (38.1)
41 (38)
43 (34.7)
35 (41.7) / 52 (61.9)
67 (62)
81 (65.3)
49 (58.3) / 0.9
Hospital and ICU variables / 111 (37) / 189 (63) / 0.5
Type
University hospital
Other / 37 (15.2)
20 (12.8) / 207 (84.8)
136 (87.1) / 0.5 / 57 (23.4)
31 (19.8) / 187 (76.6)
125 (80.1) / 0.6 / 93 (38.1)
58 (37.1) / 151 (61.9)
98 (62.8) / 0.6
Location of hospital
Paris area
Other / 19 (9.3)
38 (19.4) / 185 (90.7)
158 (80.6) / 0.029 / 41 (20.1)
47 (24) / 163 (79.9)
149 (76) / 0.4 / 68 (33.3)
83 (42.3) / 136 (66.7)
113 (57.7) / 0.2
Existence of a geriatric unit / 43 (14.3) / 257 (85.7) / 0.6 / 70 (23.3) / 230 (76.7) / 0.8 / 111 (37) / 189 (63) / 0.5
Number of ICU acute beds, n (%)
≤11
>11 / 22 (12.2)
35 (15.9) / 158 (87.8)
185 (84.1) / 0.5 / 39 (21.7)
49 (22.3) / 141 (78.3)
171 (77.7) / 0.9 / 66 (36.7)
85 (38.6) / 114 (63.3)
135 (61.4) / 0.8
Number of intermediate beds, n (%)
0
1-5
>5 / 17 (17)
12 (10.3)
28 (15.2) / 83 (83)
104 (89.7)
156 (84.8) / 0.3 / 27 (27)
23 (19.8)
38 (20.7) / 73 (73)
93 (80.2)
146 (79.3) / 0.9 / 48 (48)
36 (31)
67 (36.4) / 52 (52)
80 (69)
117 (63.6) / 0.3
Patient-to-physician ratio
≤0.5
>0.5 / 47 (14.5)
10 (13.2) / 277 (85.5)
66 (86.8) / 0.9 / 67 (20.7)
21 (27.6) / 257 (79.3)
55 (72.4) / 0.4 / 118 (36.4)
33 (43.4) / 206 (63.6)
43 (56.6) / 0.4
Patient-to-resident ratio
≤0.25
>0.25 / 33 (15)
24 (13.3) / 187 (85)
156 (86.7) / 0.5 / 53 (24.1)
35 (19.4) / 167 (75.9)
145 (80.6) / 0.3 / 92 (41.8)
59 (32.8) / 128 (58.2)
121 (67.2) / 0.22
Number of available ICU beds
0
1
2
>2 / 23 (47.9)
19 (15.3)
6 (5.6)
9 (7.5) / 25 (52.1)
105 (84.7)
102 (94.4)
111 (92.5) / <0.0001 / 25 (52.1)
28 (22.6)
19 (17.6)
16 (13.3) / 23 (47.9)
96 (77.4)
89 (82.4)
104 (86.7) / <0.0001 / 24 (50)
50 (40.3)
40 (37)
37 (30.8) / 24 (50)
74 (59.7)
68 (63)
83 (69.2) / 0.18
NIV, non-invasive ventilation; IMV, invasive mechanical ventilation; RRT, renal replacement therapy; IADL, Instrumental Activities of Daily Living score (1); ADL, Activities of Daily Living score (2); ICU, intensive care unit.
Supplementary variables tested in the model and found not significant included patient-related variables (place of residence and fall in the last 6 months) and hospital and ICU variables (number of hospital beds, patient-to-nurse ratio, and 12-hours nurse shifts).
*The model could not test the association because of perfect separation.
1
Resource 5. Determinants of decisions to use life-sustaining treatments made after receiving information on patient preferences and quality of life (univariate analysis).
NIV / IMV / RRT after IMVPatient’s variables / Refused
N=68 / Accepted
N=332 / p value / Refused
N=156 / Accepted
N=244 / p value / Refused
N=243 / Accepted
N=157 / p value
Age, years, n, (%)
≤85
>85 / 27 (12.1)
41 (23.3) / 197 (87.9)
135 (76.7) / 0.036 / 65 (29)
91 (51.7) / 159 (71)
85 (48.3) / 0.002 / 113 (50.4)
130 (73.9) / 111(49.6)
46 (26.1) / 0.0016
Gender
Female
Male / 53 (19.5)
15 (11.7) / 219 (80.5)
113 (88.3) / 0.18 / 125 (46)
31 (24.2) / 147(54)
97 (75.8) / 0.003 / 182 (66.9)
61 (47.7) / 90 (33.1)
67 (52.3) / 0.016
Marital status, n, (%)
Single or widowed
Married or living with a partner / 51 (16.8)
17 (17.7) / 253 (83.2)
79 (82.3) / 0.9 / 117 (38.5)
39 (40.6) / 187 (61.5)
57 (59.4) / 0.9 / 184 (60.5)
59 (61.5) / 120 (39.5)
37 (38.5) / 0.9
Place of residence
At home
Others / 38 (14.6)
30 (21.4) / 222 (85.4)
110 (78.6) / 0.25 / 84 (32.3)
72 (51.4) / 176 (67.7)
68 (48.6) / 0.02 / 142 (54.6)
101 (72.1) / 118 (45.4)
39 (27.9) / 0.02
Previous ICU admission, n, (%)
No
At least once / 55 (17.2)
13 (16.3) / 265 (82.8)
67 (83.8) / 0.85 / 122 (38.1)
34 (42.5) / 198 (61.9)
46 (57.5) / 0.6 / 193 (60.3)
50 (62.5) / 127 (39.7)
30 (37.5) / 0.9
Hospitalisation in the last year / 34 (22.4) / 118 (77.6) / 0.14 / 71 (46.7) / 81 (53.3) / 0.11 / 92 (60.5) / 60 (39.5) / 1
Co-morbid conditions, n, (%)
Cardiac
No
Yes
Respiratory
No
Yes
Neurologic
No
Yes
Oncologic
No
Yes / 32 (17.8)
36 (16.4)
40 (15.2)
28 (18.9)
54 (16.5)
14 (19.4)
51 (16.6)
17 (18.5) / 148 (82.2)
184 (83.6)
212 (84.1)
120 (81.1)
274 (83.5)
58 (80.6)
257 (83.4)
75 (81.5) / 0.9
0.7
0.8
0.7 / 75 (41.7)
81 (36.8)
92 (36.5)
64 (43.2)
130 (39.6)
26 (36.1)
123 (39.9)
33 (35.9) / 105 (58.3)
139 (63.2)
160 (63.5)
84 (56.8)
198 (60.4)
46 (63.9)
185 (60.1)
59 (64.1 / 0.5
0.3
0.9
0.7 / 109 (60.6)
134 (60.9)
149 (59.1)
94 (63.5)
196 (59.8)
47 (65.3)
187 (60.7)
56 (60.9) / 71 (39.4)
86 (39.1)
103 (40.9)
54 (36.5)
132 (40.2)
25 (34.7)
121 (39.3)
36 (39.1) / 1
0.5
0.6
0.9
IADL score (restricted activities), n (%)
Full self-sufficiency (IADL=0)
Limited self-sufficiency (IADL 1 to 4) / 40 (12.3)
28 (36.8) / 284 (87.7)
48 (60.2) / 0.0009 / 111(34.3)
45 (59.2) / 213 (65.7)
31 (40.8) / 0.0013 / 175 (54)
68 (89.5) / 149 (46)
8 (10.5) / 0.0001
ADL score, n, (%)
Full self-sufficiency (ADL=6)
Limited self-sufficiency, (ADL 0 to 5) / 43 (14.1)
25 (26) / 261 (85.9)
71 (74) / 0.064 / 108 (35.5)
48 (50) / 196 (64.5)
48 (50) / 0.11 / 175 (57.6)
68 (70.8) / 129 (42.4)
28 (29.2) / 0.11
WHO-QOL BREF*, n (%)
Overall perception of QOL
≤ 70
> 70
Physical health
≤ 65
> 65
Psychological health
≤ 65
> 65
Social relationships
≤ 65
> 65
Environment
≤ 75
> 75 / 162(71.1)
81 (47.1)
129 (68.6)
114 (53.3)
145 (67.1)
98 (53.3)
102 (65.4)
141 (57.8)
174 (70.2)
69 (45.4) / 66 (28.9)
91 (52.9)
59 (31.4)
98 (46.2)
71 (32.9)
86 (46.7)
54 (34.6)
103 (42.2)
74 (29.8)
83 (54.6) / 0.0015
0.046
0.07
0.3
0.0015 / 110 (48.2)
46 (26.7)
88 (46.8)
68 (32.1)
91 (42.1)
65 (35.3)
69 (44.2)
87 (35.7)
121 (48.8)
35 (23) / 118 (51.8)
126 (73.3)
100 (53.2)
144 (67.9)
125 (57.9)
119 (64.7)
87 (55.8)
157 (64.3)
127 (51.2)
117 (77) / 0.006
0.051
0.31
0.25
0.0006 / 162 (71.1)
81 (47.1)
129 (68.6)
114 (53.8)
145 (67.1)
98 (53.3)
102 (65.4)
141 (57.8)
174 (70.2)
69 (45.4) / 66 (28.9)
91 (52.9)
59 (31.4)
98 (46.2)
71 (32.9)
86 (46.7)
54 (34.6)
103 (42.2)
74 (29.8)
83 (54.6) / 0.0015
0.046
0.07
0.3
0.0015
WHO-QOL OLD**, n (%)
Sensory abilities
≤ 75
> 75
Autonomy
≤ 65
> 65
Past, present and future activities
≤ 65
> 65
Social participation
≤ 70
> 70
Death and dying
≤ 80
> 80
Intimacy
≤ 75
> 75 / 54 (21.8)
14 (9.2)
48 (21.8)
20 (11.1)
50 (25)
18 (9)
51 (20.9)
17 (10.9)
45 (22.5)
23 (11.5)
55 (17.4)
13 (15.5) / 194 (78.2)
138 (90.8)
172 (78.2)
160 (88.9)
150 (75)
182 (91)
193 (79.1)
139 (89.1)
155 (77.5)
177 (88.5)
261 (82.6)
71 (84.5) / 0.018
0.04
0.003
0.07
0.048
0.7 / 114 (46)
42 (27.6)
105 (47.7)
51 (28.3)
100 (50)
56 (28)
101 (41.4)
55 (35.3)
86 (43)
70 (35)
122 (38.6)
34 (40.5) / 134 (54)
110 (72.4)
115 (52.3)
129 (71.7)
100 (50)
144 (72)
143 (58.6)
101 (64.7)
114 (57)
130 (65)
194 (61.4)
50 (59.5) / 0.02
0.01
0.004
0.5
0.4
0.8 / 170 (68.5)
73 (48)
153 (69.5)
90 (50)
152 (76)
91 (45.5)
153 (62.7)
90 (57.7)
134 (67)
109 (54.5)
198 (62.7)
45 (53.6) / 78 (31.5)
79 (52)
67 (30.5)
90 (50)
48 (24)
109 (54.5)
91 (37.3)
66 (42.3)
66(33)
91 (45.5)
118 (37.3)
39 (46.4) / 0.007
0.01
<.0001
0.5
0.08
0.3
Patient preferences
Acceptance
I don’t know, I want the physician to decide
Refusal / 15 (5.5)
5 (25)
48 (44.4) / 257 (94.5)
15 (75)
60 (55.6) / <0.0001 / 56 (20.6)
18 (90)
82 (75.5) / 216 (79.4)
2 (10)
26 (24.1) / <0.0001 / 127 (46.7)
19 (95)
97 (89.8) / 145 (53.3)
1 (5)
11 (10.2) / <0.001
Physician variables
Age, years±SD
<40
40 to 50
>50 / 33 (15.6)
29 (22)
6 (10.7) / 179 (84.4)
103 (78)
50 (89.3) / 0.14 / 90 (42.5)
48 (36.4)
18 (32.1) / 122 (57.5)
84 (63.6)
38 (67.9) / 0.6 / 135 (63.7)
76 (57.6)
32 (57.1) / 77 (36.3)
56 (42.4)
24 (42.9) / 0.4
Gender
Female
Male / 24 (16.2)
44 (17.5) / 124 (83.8)
208 (82.5) / 0.6 / 58 (39.2)
98 (38.9) / 90 (60.8)
154 (61.1) / 0.9 / 93 (62.8)
150 (59.5) / 55 (37.2)
102 (40.5) / 0.4
Religious beliefs, n
No
Yes / 51 (16.8)
17 (17.7) / 253 (83.2)
79 (82.3) / 0.6 / 119 (39.1)
37 (38.5) / 185 (60.9)
59 (61.5) / 0.7 / 190 (62.5)
53 (55.2) / 114 (37.5)
43 (44.8) / 0.4
Time working in ICUs
≤10 years
>10 years / 3 (15)
65 (17.1) / 17 (85)
315 (82.9) / 0.5 / 25 (34.7)
148 (38.9) / 47 (65.3)
197 (60.9) / 0.7 / 12 (60)
231 (60.8) / 8 (40)
149 (39.2) / 1
Time working in the study ICU
≤10 years
>10 years / 12 (16.7)
56 (17.1) / 60 (83.3)
272 (82.9) / 0.7 / 8 (40)
148 (38.9) / 12 (60)
232 (61.1) / 0.5 / 45 (62.5)
198 (60.4) / 27 (37.5)
130 (39.6) / 0.7
Number of duties per month
<4
4
5
≥5 / 14 (16.7)
15 (13.9)
25 (20.2)
14 (16.7) / 70 (83.3)
93 (86.1)
99 (79.3)
70 (83.3) / 0.6 / 31 (36.9)
44 (40.7)
49 (39.5)
32 (38.1) / 53 (63.1)
64 (59.3)
75 (60.5)
52 (61.9) / 1 / 51 (60.7)
62 (57.4)
72 (58.1)
58 (69) / 33 (39.3)
46 (42.6)
52 (41.9)
26 (31) / 0.4
Hospital and ICU variables
Type
University hospital
Other / 44 (18)
24 (35.2) / 200(82)
132 (39.7) / 0.5 / 105 (43)
51 (32.6) / 139 (57)
125 (51.2) / 0.6 / 153 (62.7)
90 (37.0) / 91 (37.3)
66 (27.1) / 0.8
Hospital place
Paris area
Other / 31 (15.2)
37 (18.9) / 173 (84.8)
159 (81.1) / 0.5 / 80 (39.2)
76 (38.8) / 124 (60.8)
120 (61.2) / 0.8 / 126 (61.8)
117 (59.7) / 78 (38.2)
79 (40.3) / 0.5
Existence of a geriatric unit / 49 (16.3) / 251 (83.7) / 0.6 / 115 (38.3) / 185 (61.7) / 1 / 180 (60) / 120 (40) / 0.7
Number of ICU acute beds, n (%)
≤11
>11 / 22 (12.2)
46 (20.9) / 158 (87.8)
174 (79.1) / 0.055 / 61 (33.9)
95 (43.2) / 119 (66.1)
125 (56.8) / 0.34 / 107 (59.4)
136 (61.8) / 73 (40.6)
84 (38.2) / 0.9
Number of intermediate beds, n (%)
0
1-5
>5 / 20 (20)
19 (16.4)
29 (15.8) / 80 (80)
97 (83.6)
155 (84.2) / 0.9 / 38 (38)
41 (35.3)
77 (41.8) / 62 (62)
75 (64.7)
107 (58.2) / 0.6 / 65 (65)
68 (58.6)
110 (59.8) / 35 (35)
48 (41.4)
74 (40.2) / 0.8
Patient-to-physician ratio
≤0.5
>0.5 / 53 (16.4)
15 (19.7) / 271 (83.65)
61(80.3) / 0.4 / 129 (39.8)
27 (35.7) / 195 (60.2)
49 (64.5) / 0.6 / 193 (59.6)
50 (65.8) / 131 (40.4)
26 (34.2) / 0.22
Patient-to-resident ratio
≤0.25
>0.25 / 37 (16.8)
31 (17.2) / 183 (83.2)
149 (81.8) / 0.6 / 97 (44)
59 (32.8) / 123 (55.9)
121 (67.2) / 0.17 / 139 (63.2)
104 (57.8) / 81 (36.8)
76 (42.2) / 0.6
Patient-to-nurse ratio (day)
≤2.5
>2.5 / 43 (19.2)
25 (14.2) / 181 (80.9)
151 (85.8) / 0.3 / 100 (44.6)
56 (31.8) / 124 (55.4)
120 (68.2) / 0.043 / 152 (67.9)
91 (51.7) / 72 (32.1)
85 (48.3) / 0.01
12-hours nurse shifts / 44 (13.9) / 232 (84.1) / 0.5 / 111 (40.2) / 165 (59.8) / 0.4 / 175 (63.4) / 101 (36.6) / 0.08
Number of available ICU beds
0
1
2
>2 / 16 (33.3)
24 (19.4)
14 (13)
14 11.7) / 32 (66.7)
100 (80.6)
94 (87)
106 (88.3) / 0.0067 / 25 (52.1)
50 (40.3)
42 (38.9)
39 (32.5) / 23 (47.9)
74 (59.7)
66 (61.1)
81(67.5) / 0.096 / 33 (68.8)
83 (66.9)
61 (56.5)
66 (55) / 15 (31.3)
41 (33.1)
47 (43.5)
54 (45) / 0.10
NIV, non-invasive ventilation; IMV, invasive mechanical ventilation; RRT, renal replacement therapy; IADL, Instrumental Activities of Daily Living score (2); ADL, Activity of Daily Living score (1); ICU, intensive care unit
* To assess quality of life, we used the World Health Organisation Quality Of Life scale WHOQOL-BREF with 26 items covering four domains: physical health, psychological health, social relationships, and the environment (3)
** The WHO-QOL OLD was developed as an add-on module that can be used with other WHO-QOL instruments to specifically address important facets of quality of life in older adults. It has 24 items covering six domains (sensory abilities; autonomy; past, present, and future activities; social participation; death and dying; and intimacy) (4)
Supplementary variables tested in the model and found not significant included patient-related variables (religious beliefs, fall in the last 6 months, and depression), a physician-related variable (religious beliefs), and an hospital related variable (number of hospital beds).
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REFERENCES
1.Katz S. Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. (1983) J Am GeriatrSoc 31:721-727.
2.Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. (1969) Gerontologist 9:179-186.
3.Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group (2004) Qual Life Res 13:299-310.
4.Power M, Quinn K, Schmidt S. Development of the WHOQOL-OLD module (2005) Qual Life Res 14:2197-2214.
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