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Adrienne G. Randolph, MD, MSc

JAMA. 1999;281:1330-1331.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The task of clearly demonstrating that the type of care delivered in an intensive care unit (ICU) ultimately affects patient outcomes is a challenge. It rarely is feasible to manipulate already-established ICU characteristics. Randomly assigning patients to ICUs that do or do not have certain organizational features, such as ICU subspecialists performing daily patient rounds or nurse-to-patient ratios of less than 1:2, is logistically complex. Therefore, investigators who wish to explore the relationship between patient outcome and the structure and function of ICUs need to extract data from large databases that contain a representative sample of ICUs, identify their organizational characteristics, and use risk adjustment methods¹ to evaluate the association of these characteristics with the health outcomes of interest. Risk adjustment ideally takes into account underlying differences in the pre-ICU care patient population among ICUs, the individual performance of each ICU, and differences in post-ICU . . . [Full Text of this Article]

Author Affiliation: Departments of Pediatrics and Anesthesia, Harvard Medical School and Children's Hospital, Boston, Mass.

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