Outcome, Process, Utilization, and Cost Measurements of Patients Admitted to the ICU in Hospitals With Vs. Without an Intermediate Care Unit: A Nationwide Inpatient Database Study.

OBJECTIVE To assess the impact of the presence of an intermediate care unit (IMCU) on ICU patient-level clinical outcomes as well as hospital-level utilization and cost measures by comparing those with vs without an IMCU, using Japan's nationwide inpatient database. DESIGN Nationwide retrospective cohort study. SETTING Acute-care hospitals in Japan participating in the Diagnosis Procedure Combination Study Group database and Hospital Bed Function Reports from 2016 to 2022. PATIENTS A total of 2,278,521 adult patients admitted to the ICU between April 2016 and March 2023. INTERVENTIONS ICU admission to hospitals with vs without an IMCU. MEASUREMENTS AND MAIN RESULTS Outcomes included patient-level (in-hospital and ICU mortality, ICU readmission, and length of ICU stay) and hospital-year level (resource utilization and hospitalization costs) measures. Among the 2,278,521 eligible ICU patients from 557 hospitals across 2,953 hospital-years, 1,771,000 (77.7%) patients were admitted to hospitals with both an ICU and IMCU. Overall, 14.3% of patients were transferred between the ICU and IMCU, with large variability between hospitals. When estimating participant-average treatment effect for patient-level outcomes, ICU patients in IMCU-equipped hospitals had lower in-hospital mortality (adjusted odds ratio [aOR] 0.94; 95% CI, 0.89-0.99), ICU mortality (aOR 0.87; 0.83-0.92), fewer ICU readmissions (aOR 0.92; 95% CI, 0.85-1.00), and shorter ICU stays (adjusted rate ratio 0.98; 95% CI, 0.98-0.99). When estimating cluster-average treatment effect for hospital-level outcomes, IMCU-equipped hospitals had higher ICU bed occupancy (mean difference: 5.5%, 95% CI, 3.3-7.7%), higher occupancy for life-sustaining therapies (8.6%, 95% CI, 7.7-9.5%), increased reimbursement rates (5.4%, 95% CI, 4.0-6.8%), and increased annual revenue per ICU bed (25 million JPY, 19-31 million JPY). CONCLUSIONS The presence of an IMCU in ICU-equipped hospitals was associated with improved patient outcomes and more efficient ICU utilization, with only modest increase in hospitalization costs. These findings support integration of the IMCU into critical care systems.

• Publication year

  2025

• Venue

  Critical Care Medicine

• Publication date

  2025-11-11

• Fields of study

  Medicine

• Identifiers
  DOI 10.1097/CCM.0000000000006962PMID 41217377
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• In-hospital mortality of patients admitted to the intermediate care unit in hospitals with and without an intensive care unit: a nationwide inpatient database study

  2025cited by this paper
• Outcomes and cost-effectiveness of intermediate care units for patients discharged from the intensive care unit: a nationwide retrospective observational study

  2025cited by this paper
• Utility of Intermediate Care Units: A Systematic Review Study

  2024cited by this paper
• Updated information on the Diagnosis Procedure Combination data

  2024cited by this paper
• Regional Critical Care Bed Capacity and Incidence and Mortality of Mechanical Ventilation in Japan.

  2024cited by this paper
• Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation

  2024cited by this paper
• The Role of Intermediate Care in Supporting Critically Ill Patients and Critical Care Infrastructure.

  2024cited by this paper
• Estimands in cluster-randomized trials: choosing analyses that answer the right question

  2022cited by this paper
• Development and validation of a procedure‐based organ failure assessment model for patients in the intensive care unit: an administrative database study

  2021cited by this paper
• Intensive care unit versus high-dependency care unit for mechanically ventilated patients with pneumonia: a nationwide comparative effectiveness study

  2021cited by this paper
• Intermediate Care Units: A Survey of Organization Practices Across the United States

  2020cited by this paper
• The Impact of Step-Down Unit Care on Patient Outcomes After ICU Discharge

  2020cited by this paper
• Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020

  2020cited by this paper
• Scientists rise up against statistical significance

  2019cited by this paper
• The intermediate care unit as a cost-reducing critical care facility in tertiary referral hospitals: a single-centre observational study

  2019cited by this paper
• Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach

  2018cited by this paper
• Sensitivity Analysis in Observational Research: Introducing the E-Value

  2017cited by this paper
• What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine

  2017cited by this paper
• Validity of diagnoses, procedures, and laboratory data in Japanese administrative data

  2017cited by this paper
• ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research

  2016cited by this paper
• The impact of the organization of high-dependency care on acute hospital mortality and patient flow for critically ill patients.

  2015cited by this paper
• Does intermediate care improve patient outcomes or reduce costs?

  2015cited by this paper
• Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study

  2014cited by this paper
• Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study

  2014cited by this paper
• Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012

  2013cited by this paper
• Predicting death and readmission after intensive care discharge.

  2008cited by this paper
• Changes in intensive care unit performance measures associated with opening a dedicated thoracic surgical progressive care unit.

  2008cited by this paper
• The effect of an intermediate care unit on the demographics and outcomes of a surgical intensive care unit population.

  2004cited by this paper
• Waiting for the break of dawn?

  2002cited by this paper
• Waiting for the break of dawn? The effects of discharge time, discharge TISS scores and discharge facility on hospital mortality after intensive care.

  2002cited by this paper
• Does the introduction of HDU reduce surgical mortality?

  1999cited by this paper
• The immediate impact of opening an adult high dependency unit on intensive care unit occupancy

  1999cited by this paper
• Value of a surgical high‐dependency unit

  1999cited by this paper
• The impact of a high‐dependency unit on the workload of an intensive care unit

  1998cited by this paper
• Clinical Investigations in Critical CareClosure of an Intermediate Care Unit: Impact on Critical Care Utilization

  1993cited by this paper
• Decreases in mortality on a large urban medical service by facilitating access to critical care. An alternative to rationing.

  1988cited by this paper
• Impact of an intermediate care area on ICU utilization after cardiac surgery

  1986cited by this paper

• No citing papers are available for this paper.