ORIE Colloquium, 2013-12-03 - Song-Hee (Hailey) Kim (Columbia): ICU Admission Control: An Empirical Study of Capacity Allocation and its Implication on Patient Outcomes
From E. Cornelius
Tuesday, December 3, 2013 at 4:15pm Frank H. T. Rhodes Hall, 253 ORIE Colloquium: Song-Hee (Hailey) Kim (Columbia) - ICU Admission Control: An Empirical Study of Capacity Allocation and its Implication on Patient Outcomes We examine admission control of the Intensive Care Unit (ICU) which provides care for a hospital’s most critically ill patients. Using data of nearly 200,000 hospitalizations from an integrated healthcare delivery system, we build an econometric framework to show that although medical necessity plays a key role, operational factors such as ICU occupancy also determines which patients receive ICU care. In addition to describing the actual admission policy used by hospitals, this econometric model provides instrumental variables that can be used to identify the effect of endogenous ICU admission decisions on patient outcomes. We analyze a stylized model for ICU admission control and use our empirical results and simulation to evaluate the performance of alternative admission policies. We find that both our derived optimal policies —based solely on objective metrics— and the current policies —which use physicians’ discretion that cannot be captured by the available objective metrics— have distinct advantages under different settings. We believe our work, which studies the role of both objective metrics and doctors’ discretionary criteria on ICU performance, is an important step in establishing an evidence-based decision support for providing ICU care.