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em sought input only from critical care professionals, who are a fraction of all the stakeholders," said Dr. Barnato, lead author of the report. "These groups often stated the need for more trained providers. Surveying a wider group of interested parties, we found that this isn't necessarily the best or only solution."

For the PrOMIS Conference, organizers attempted to identify problems in the current U.S. critical care system as seen by all stakeholders, including those from professional organizations, critical care and non-critical care physicians, federal and private health insurers, federal and private funding organizations, and the general public. Prior to the conference, attendees selected from each of the stakeholder groups were asked to fill out a survey aimed at identifying problems in the organization and delivery of critical care services. Respondents then attended a two-day conference held in the Washington, D.C. area, where current data on organization and management of critical care services was presented. Attendees then participated in break-out groups where they discussed the themes and issues identified by the pre-conference survey.

In the paper, researchers say the primary concern voiced by participants was that the "utilization, organization and management of intensive care services in the United States was not optimal." They broadly agreed that there was a need to regionalize and tier the critical care system, similar to what previously had been done by the U.S. trauma system. Such a system would require the most critically ill patients to be seen in top-level critical care centers. Lower-level centers would not provide ongoing critical care services, but would need to transfer critically ill patients to higher-level centers.

Participants also cited the need to acknowledge that some critical care services should be provided by physicians, such as hospitalists and emergency physicians, who currently are not certif
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Contact: Jocelyn Uhl Duffy
UhlJH@upmc.edu
412-647-3555
University of Pittsburgh Schools of the Health Sciences
18-Apr-2007

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