• Kiyohide Fushimi, Hiroshi Ikai, and Yuichi Imanaka.
• Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
• Crit Care Resusc. 2013 Mar 1;15(1):28-32.

ObjectiveTo compare patient outcomes in hospitals certified by the Japanese Society of Intensive Care Medicine (JSICM) as training facilities for intensive care specialists with patient outcomes in hospitals not certified by the JSICM (non-CFs).DesignA retrospective case-control study using administrative data.Main Outcome MeasureInhospital mortality.Results164 803 intensive care unit admissions were identified between 1 April 2008 and 31 March 2010, of which 159 540 were for adults (≥18 years). A total of 50 875 patients in 125 hospitals were admitted to certified facilities (CFs) and 108 665 patients in 309 hospitals were admitted to non-CFs. Inhospital mortality rates were 9.9% and 10.6% in CFs and non-CFs, respectively (P < 0.001). After adjusting for age, emergency admission, admission route, use of vasopressors, mechanical ventilation, and renal replacement therapy, the odds ratio for hospital mortality in CF-treated patients was 0.81 (95% confidence interval, 0.78-0.85). The c statistic of the model was 0.881.ConclusionsPatients admitted to the intensive care unit in CFs had better outcomes. To improve patient outcomes, more board-certified intensivists are required in Japan.

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