Health Services Research and Outcome Section

Health Services Research and Outcome section Minutes of the Working Group on Health Economics (WGHE)

Held at the 31st ISICEM in Brussels

Date: Tuesday, 22nd March 2011 Time: 16:00 Location: The Square room 202

Attendants: only the head of the WG (Didier Ledoux) was present.

The meeting was scheduled late in a busy day. People previously interested in the ELOISE project were the same attending the Quality Improvement and HSRO Section meetings. Hence, Didier Ledoux (DL) made a short presentation during the HSRO section meeting and this is the report about this. He summarized the comments made by 7 of the 8 steering committee members (SCM) (one did not sent comments nor acknowledge reception of the protocol). Some attendees of the HSRO meeting made comments: - Since apparently the aim of the ELOISE project is not clear to everyone the aim of the study was repeated: ELOISE primary aim is: To assess whether the patients admitted to ICUs with availability of IMCU have lower hospital mortality than those admitted to the ICU without availability of IMCU. To compare ICU (LOIS) and hospital (LOHS) lengths of stay of patients admitted to ICUs with or without availability of IMCU. The LOIS will be used as a surrogate of ICU costs. ELOISE secondary aims are: To identify structure and organization predictors of LOIS/LOHS. To assess the influence of IMCU on the rate of ICU readmissions. - Severity assessment: o All replying SCM agree on the use of SAPS 3

o Everyone agreed that SAPS 3 can not be used for IMCU patients

o SOFA on admission to and departure form ICU / IMCU

- SCM believe the free ICU beds and ICU occupancy rate is also an important secondary objective to demonstrate the ICU facilities to admit a patient. This should also be adjusted on ICU resources: ratio ICU/hospital beds. - Patients’ level of care in the different areas (ICUs & IMCUs) should be included - We need to know the number of hospital beds dedicated to ICU. DL comment: this is in in the Hospital questionnaire presented in Barcelona last year. - Ask the number of ICU beds devoted to high level of care treatment (level II/III) - Ask if ICUs have the possibility to allocate extra beds without additional personnel/facilities. - Need to collect the number of physician per bed (including residents) at morning of working days, at night. DL comment: this is in in the Hospital questionnaire presented in Barcelona last year. - SCM underline the importance of the use of precise definitions to prevent misunderstanding. o They suggest to use the latest definition of level of care that will be published in the paper on Basic requirements for ICUs o One SCM proposes the following definition for the IMCU: “A high dependency unit (HDU or IMCU) is characterized by the maximum provided LOC that does not exceed level I.” - One SCM found the term “resident” confusing term and proposed this definition: “A resident is a young doctor in training for a fraction of year and who is not allowed to work in autonomy.” - Specific step-down units (COPB, neuromuscular disease, spinal trauma,...) will not be part of the project. - Mixed ICU-IMCU will be taken in the project but must be analysed separately.

Several comments/criticism were made on the project. DL remind everyone that this project, proposed by Paolo Merlani, was chosen by the majority of the WGHE members and that now it was necessary either to move one and start the study or to stop the project. It was acknowledge that we should move on and go for the pilot phase.

Personal note: I have the perception that WGHE members are not very happy with the way group is working. I have the feeling that they are not happy having me as the head. It is indeed true that I am not an expert in the HE field and I do not think I deserve the position I hold. Furthermore I have, like all of us, several other duties that do not leave me enough time to allow me to adequately conduct the WGHE projects. Therefore I propose that someone else takes the head of the Working Group on Health Economics.

The next meeting will be held at the next ESICM congress in Berlin. Date and location will be communicated as soon as possible.

Didier Ledoux