Qualitative review of intensive care unit quality indicators☆,☆☆
Section snippets
Study selection criteria
We sought to identify and review all studies that provide a potential measure of quality of ICU care and that met the following criteria: design: observational studies, experimental trials, or systematic reviews; population: critically ill patients, and intervention: a process (what we do to patients) or structure (how we deliver care) measure that was associated with improved patient outcomes: including morbidity, mortality, complications, error, costs, length of stay (LOS), and
Study selection and characteristics
We identified 3,014 citations from the electronic search. Of these, we rejected 2,948 (98%) after re-view of the abstracts because they did not meet our selection criteria. Sixty-six studies met selection criteria, with 99% agreement in the selection of eligible articles between reviewers. These studies reported on a variety of interventions. These results, and the potential indicators, are summarized in Table 1.
Outcome Evaluated Study Design Intervention Studied
Conclusions
The ability to measure quality of care is becoming increasingly important. Patients and purchasers are beginning to make health care purchasing decisions based on quality of care. We have conducted an informal review of the literature and identified several potential ICU quality indicators. This study advances the science of ICU quality measures by moving beyond risk-adjusted mortality and providing a framework for developing a rigorously evaluated set of quality measures.
Controversy exists
Acknowledgements
The authors would like to acknowledge Firouzeh Manuchehri for help on the logic critique and evaluation of the indicators and for providing feedback during the conduct of the study. The authors would also like to thank Sherrie Solomon for her assistance during the preparation of the manuscript.
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Supported by a grant from the Volunteer Hospitals of America, Inc. S.M.B. and P.J.P. are supported in part by a clinician scientist award from The Johns Hopkins University.
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Address reprint requests to Sean M. Berenholtz, MD, Department of Anesthesiology/CCM, The Johns Hopkins University, 600 N. Wolfe St, Halsted 842, Baltimore, MD 21287.