Why is there such a difference in outcome between Australian intensive care units and others?

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Abstract
The aim of this article is to assess the data on clinical outcomes for critically ill patients admitted to Australian and New Zealand intensive care units in comparison to information available for similar patients in other counties Australia and New Zealand have been collecting standardized data intensive care unit admissions for over a decade. The Australian and New Zealand Intensive Care Society Database Management Committee has developed a high quality database of close to 600 000 adult intensive care unit admissions. Although comparisons suffer from significant methodological, case-mix and process differences, which make their findings easily subject to criticism, interrogation of this database and of data from clusters of intensive care units within this system consistently yields patient outcomes, which are better than outcomes reported from other nations or international studies for similar patients. In addition, Australia and New Zealand has now achieved the highest rate of patient enrollment in an investigator-initiated multicentre randomized controlled trials. Although comparisons in outcome between Australia and New Zealand intensive care units and other units worldwide may not have sufficient scientific rigour to truly reflect better national outcomes, many features of Australian and New Zealand units are unique and worthy of consideration by other national systems as they consider their strategic national goals for the next decade.