The Effect of Intensive Care Unit Admission Patterns on Mortality-based Critical Care Performance Measures

Barbash, Ian J.; Le, Tri Quang; Pike, Francis; Barnato, Amber E.; Angus, Derek C.; Kahn, Jeremy M.

doi:10.1513/annalsats.201509-645oc

Cited by 7 publications

(7 citation statements)

References 55 publications

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“…Challenges with data quality were described at point of data capture and extraction [30,33,34,40,63,84,87,90,101,108,118,120,143]. Ability to accurately measure processes of care associated with the indicator (e.g., time of antibiotic administration in the context of recognition of infection/ prescription of antibiotics) hindered utilization of the indicator in care evaluations [32,46,50,51,58,98,103,120,144,145].…”

Section: Operationalmentioning

confidence: 99%

A scoping review of registry captured indicators for evaluating quality of critical care in ICU.

Jawad¹,

Rashan²,

Sigera³

et al. 2021

Preprint

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Background Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management [1–3]. Routine measurement of quality indicators through an EHR or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing Indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on quality indicators (QIs) for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and the reported challenges of implementation.Method We searched MEDLINE, EMBASE, CINAHL and the Cochrane libraries from the earliest available date through to January 2019. To increase sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform- or Electronic Health Record (EHR) adapted for quality of care surveillance.Results The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. 51 unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%) hospital processes (54.9%) and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%).Conclusions Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritised and include greater focus on measuring discriminable processes of care.

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Section: Operationalmentioning

confidence: 99%

A scoping review of registry captured indicators for evaluating quality of critical care in ICU.

Jawad¹,

Rashan²,

Sigera³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Challenges with data quality were described at point of data capture and extraction [29, 30, 32, 35, 38-40, 42, 46, 51, 54, 64, 72]. Ability to accurately measure processes of care associated with the indicator (e.g., time of antibiotic administration in the context of recognition of infection/ prescription of antibiotics) hindered utilisation of the indicator in care evaluations [33,46,53,57,58,66,67,70,71,73].…”

Section: Operationalmentioning

confidence: 99%

A scoping review of registry captured indicators for evaluating quality of critical care in ICU

et al. 2021

View full text Add to dashboard Cite

Background Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation. Method We searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance. Results The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%). Conclusions Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.

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“…In a Critical Care Medicine context, in three academic hospitals in Pennsylvania including subspecialty and mixed ICUs, P4P has been shown to increase exclusions based on eligibility yet to have no effect on mortality and adjacent outcomes [19]. However, quality of care may vary depending on patient risk and condition severity, and this is not always taken into account when measuring ICU-based patient outcomes [20]. It is consequently a possibility that some subpopulations may benefit from P4P more than others.…”

Section: Main Textmentioning

confidence: 99%

An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients

Kyeremanteng

Robidoux

D’Egidio

et al. 2019

Critical Care Research and Practice

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Pay-for-performance (P4P) programs have been introduced into the Canadian medical system in the last decades. This paper examines the underlying characteristics of P4P and describes both their advantages and drawbacks. Most P4P programs provide the advantage of rewarding medical acts, thus providing an incentive to take on complex patients. There is a variety of nuanced P4P initiatives, which provide financial incentive according to differing criteria, based on quality measures, incentives, and/or benchmark structures. However, there is no conclusive evidence demonstrating that P4P programs provide better value for money than traditional pay schemes, regardless of particular structural choices. Some evidence has even shown that P4P may be detrimental, especially in disadvantaged and high-risk populations. Additionally, there are a number of ethical and practical concerns that arise with the use of P4P, such as the risk of financial incentives being misused or misinterpreted and patients being refused or referred during treatment. P4P initiatives require careful examination and the creation of solid, evidence-based criteria for evaluation and implementation in Canadian medical systems.

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The Effect of Intensive Care Unit Admission Patterns on Mortality-based Critical Care Performance Measures

Cited by 7 publications

References 55 publications

A scoping review of registry captured indicators for evaluating quality of critical care in ICU.

A scoping review of registry captured indicators for evaluating quality of critical care in ICU.

A scoping review of registry captured indicators for evaluating quality of critical care in ICU

An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients

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