University of Michigan's C.S. Mott Children's Hospital in top quartile for mortality of pediatric ICU patients (PRISM III assessment)

Pediatric patients receiving PICU care at C.S. Mott Children's Hospital receive excellent care

BACKGROUND
Using patient ICU admission information such as diagnosis and age, and physiologic measures such as blood pressure and blood oxygen levels, researchers, hospitals and others can predict mortality rates of children cared for in a given pediatric intensive care unit. The Pediatric Risk of Mortality Score (referred to as the PRISM III project) was developed by researchers at Children's National Medical Center in Washington, D.C., with support from the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services. It provides a tool to assess the Standardized Mortality Ratio for samples of children hospitalized in PICUs.

Many factors may impact a PICU's SMR, including unique patient populations treated at a given center, available resources (staffing, technology, etc.) and other factors yet to be understood. For example, a report by Pollack et al described an apparent association between lower (better) observed SMR and the presence of a PICU fellowship training program (Crit CareMed 1997; 25:1637-1642).

To determine SMR, the actual or observed rate of PICU mortality is divided by the predicted rate that is derived from the PRISM III model. If a hospital's PICU has higher rates of mortality than expected, the SMR for that PICU will have a value greater than "1." Similarly, SMR values less than "1" indicate a better mortality rate than expected. A SMR ratio of "1" indicates mortality rates are at levels expected by PRISM III.

DATA
Over the past eight years – from 1999 to 2007 – the PICUs at the University of Michigan C.S. Mott Children's Hospital have observed an average annual SMR of 0.74 based on a sample of 11,459 patients. This represents an average annual observed mortality rate 26 percent lower than expected based on PRISM III assessment.

Standardized Mortality Ratio 1999-2006 (fiscal year)

WHAT THIS MEANS FOR PATIENTS
The U-M's low SMR reflects better performance than expected based upon the average or typical performance observed at all other institutions who participate in the PRISM data collection. It may be concluded that pediatric patients receiving PICU care at C.S. Mott Children's Hospital receive excellent care in a top-tier facility.

FOR MORE INFORMATION
To find out more about how Mott Hospital compares in PRISM III data, contact Frank W. Moler, M.D., associate professor of Pediatrics and Communicable Diseases for the U-M Medical School, and medical director for the Pediatric Intensive Care Unit, University of Michigan Hospitals and Health Centers, at 734-764-5302 or fmoler@med.umich.edu.

To learn more about how the University of Michigan is committed to quality and appropriateness, contact John E. Billi, M.D., associate dean for Clinical Affairs, University of Michigan Medical School, at 734-936-5214, or Darrell Campbell Jr., M.D., chief of staff, University of Michigan Hospitals and Health Centers, at 734-936-5814.

For more detailed information on the medical terms used in this article, go to the University of Michigan's Health Topics A to Z.

Revised August 2007