The association between outcome-based quality indicators for intensive care units

To assess and improve the effectiveness of ICU care, in-hospital mortality rates are often used as principal quality indicator for benchmarking purposes. Two other often used, easily quantifiable, quality indicators to assess the efficiency of ICU care are based on readmission to the ICU and ICU len...

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Vydané v:PloS one Ročník 13; číslo 6; s. e0198522
Hlavní autori: Verburg, Ilona W. M., de Jonge, Evert, Peek, Niels, de Keizer, Nicolette F.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Public Library of Science 13.06.2018
Public Library of Science (PLoS)
Predmet:
Analysis
Benchmarks
Biology and Life Sciences
Correlation coefficient
Correlation coefficients
Critical care
Critical Care - standards
Efficiency
Generalized linear models
Health care
Health informatics
Health risks
Heart surgery
Hospital Mortality
Hospitals
Humans
Indicators
Intensive care
Intensive care units
Intensive Care Units - standards
Intranets
Length of Stay
Medical care quality
Medical ethics
Medical research
Medicine
Medicine and Health Sciences
Mortality
Mortality risk
Netherlands
Outcome Assessment (Health Care)
Patient admissions
Patient Readmission
People and Places
Physical Sciences
Physiology
Public health
Quality
Quality assessment
Quality control
Quality of care
Registries
Research and Analysis Methods
Risk
Subgroups
Netherlands
ISSN:1932-6203, 1932-6203
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Shrnutí:To assess and improve the effectiveness of ICU care, in-hospital mortality rates are often used as principal quality indicator for benchmarking purposes. Two other often used, easily quantifiable, quality indicators to assess the efficiency of ICU care are based on readmission to the ICU and ICU length of stay. Our aim was to examine whether there is an association between case-mix adjusted outcome-based quality indicators in the general ICU population as well as within specific subgroups. We included patients admitted in 2015 of all Dutch ICUs. We derived the standardized in-hospital mortality ratio (SMR); the standardized readmission ratio (SRR); and the standardized length of stay ratio (SLOSR). We expressed association through Pearson's correlation coefficients. The SMR ranged from 0.6 to 1.5; the SRR ranged from 0.7 to 2.1; and the SLOSR ranged from 0.7 to 1.3. For the total ICU population we found no significant associations. We found a positive, non-significant, association between SMR and SLOSR for admissions with low-mortality risk, (r = 0.25; p = 0.024), and a negative association between these indicators for admissions with high-mortality risk (r = -0.49; p<0.001). Overall, we found no association at ICU population level. Differential associations were found between performance on mortality and length of stay within different risk strata. We recommend users of quality information to take these three outcome indicators into account when benchmarking ICUs as they capture different aspects of ICU performance. Furthermore, we suggest to report quality indicators for patient subgroups.
Bibliografia:ObjectType-Article-1
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0198522