Center for Clinical Effectiveness CCE

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www.gradyhealthsystem.org

Critical Care Outcomes Prediction - APACHE III
Overview
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Prognostic Scoring Systems in Critical Care

• Therapeutic Intervention Scoring System TISS
• Mortality Predictor Model MPM
• Simplified Acute Physiology- SAP
• Acute Physiology Age and Chronic Health
  Evaluation - APACHE III

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What is APACHE ?
APACHE is a severity-adjusted methodology that
predicts outcomes for adult critically ill
patients

• Step 1 27 variables collected for each patient
  -- Vital signs, lab values, diagnosis,
  age
• Step 2 Each patients data is used to formulate
  individual predictive equations
• Step3 Predictions made regarding mortality,
  length of stay, need for active treatment

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Evolution of APACHE III
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APACHE III National Study 42 U.S.
ICUs Compares hospital and ICU mortality, LOS
Unadjusted mortality rates varied from 6.4-40
Hospitals were stratified by region, size and
teaching status
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APACHE III SCORING SYSTEM

• Variable Scoring Range
• Physiology 0-252
• Chronic Health 0 -23
• Age 0-24
• Total Range 0-299

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Acute Physiology, Age, Chronic Health Evaluation
APACHE Path Predictions
Compare to Actual Performance

• Hospital ICU Mortality
• Hospital ICU LOS
• Risk of active treatment/LRM
• Ventilator Usage
• Probability of PA Catheter
• TISS

Source CERNER Inc
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APACHE IIILead-Time Bias Variable
Lead-time bias may be defined as the difference
between the hospital admit date and the ICU admit
date. The longer the patient is hospitalized
prior to ICU admission, the greater the impact on
outcome. Lead-time bias captures the added risk
associated with a patients failure to respond to
therapy.
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APACHE III and Risk of DeathThe Importance of
Disease

HOSPITAL RISK OF DEATH
This SDH patient has an APACHE III score of
62 and a Hospital Mortality risk of 40


This GI PERF patient has an APACHE III score of
62 and a Hospital Mortality risk of 18

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Relative Prognostic Information for Hospital
Mortality
As represented in the APACHE III Score
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Relative prognostic information for ICU length of
stay
As represented in the APACHE III Score
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Overview of Data Collection
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Discover provides real-time predictions of
mortality, LOS, resource use for individual
patients to help manage quality costs.
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• Appropriateness of admission
• Objective transfer criteria
• Palliative care consult
• Nursing assignment/staffing

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APACHE III Critical Care Series - Why ICU and
APACHE ?

• ICUs consume 20-35 of US hospital costs
• JCAHO requires that hospitals implement
  ICU-specific core measures
• APACHE III selected as risk-adjusted model for
  hospital mortality and ICU-specific LOS core
  measures
• APACHE system provides the ability to derive the
  ICU core measures

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APACHE III Critical Care Series Resource and
Outcomes Management Tool

• Tracks daily clinical status of individual
  patients
• Provides objective support for clinical decisions
• Predicts individuals need of ICU care
• Provides predictions for risk of death, risk of
  requiring active treatment, and PA catheter need
• Predicts ICU and hospital length of stay (LOS),
  and expected ventilator days
• Provides support for nursing workload
  distribution
• Great resource for customized outcomes research

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APACHE III Critical Care Series ICU BDPs and
Benchmarking Tool

• APACHE best demonstrated practices (BDPs)
  identify ICUs with outstanding efficiency and
  superior performance
• Provides database that allow comparison of ICU
  performance and utilization against peer group
  and national benchmarks

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APACHE III Critical Care Series An ICU
Benchmarking Tool

• Resource utilization
• Hospital and ICU length of stay (LOS ) ratios
• ICU Readmission rates
• Low risk monitor admits
• Days on ventilator
• Nursing Workload - Therapeutic Intervention
  Scoring System (TISS )

• Severity and outcomes
• ICU case severity level ( APACHE III Score)
• Hospital and ICU mortality ratios
• Disease specific LOS and mortality ratios
• Service specific LOS and mortality ratios
• Low risk mortality reviews

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APACHE Critical Care Series JCAHO ICU
Candidate Core Measure s

• Ventilator-associated pneumonia (VAP) prevention
• Stress ulcer disease (SUD) prophylaxis
• Deep vein thrombosis (DVT) prophylaxis
• Central line-associated primary blood stream
  infection
• Risk adjusted ICU LOS by type of ICU
• Risk adjusted hospital mortality for ICU patients

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Questions?

• Answers..
• You May Call
• 404-616-0732
• 404-616-7289
• 404-616-7349
• 404-616-7772