Evaluating Critical Care: Using Health Services Research to Improve QualityWilliam J. Sibbald, Julian F. Bion Measuring the quality of a complex service like critical care that combines the highest technology with the most intimate caring is a challenge. Recently, con sumers, clinicians, and payers have requested more formal assessments and comparisons of the quality and costs of medical care [2). Donabedian [1) pro posed a framework for thinking about the quality of medical care that separates quality into three components: structure, process, and outcome. An instructive analogy for understanding this framework is to imagine a food critic evaluating the quality of a restaurant. The critic might comment on the decoration and lighting ofthe restaurant, how close the tables are to each other, the extent ofthe wine list and where the chef trained. These are all evaluations of the restaurant structure. In addition, the critic might comment on whether the service was courteous and timely - measures of process. Finally, the critic might comment on outcomes like customer satisfaction or food poisoning. Similarly, to a health care critic, structure is the physical and human resources used to deliver medi cal care. Processes are the actual treatments offered to patients. Finally,outcomes are what happens to patients, for example, mortality, quality of life,and satisfac tion with care (Table 1). There is a debate about which of these measurements is the most important measure of quality. |
Contents
Problems Boundaries and Outcomes | 3 |
A Domain where Disciplines and Decision Makers Meet | 6 |
The Structure of Intensive Care | 23 |
Process of Care Assessment and the Evaluation of Outcome from Intensive Care | 41 |
Severity of Illness | 51 |
Mortality Morbidity and Organ Dysfunction | 69 |
During and Following Critical Care | 86 |
Quality of Life and Longer Term Outcomes | 104 |
Consensus Methods and Consumer Opinon | 209 |
The Measurement of Costs and Outcome to Analyze Efficiency and Efficacy | 222 |
Assessment of Medical Devices | 244 |
Health Informatics | 255 |
Databases Registries and Networks | 270 |
Organizational Effects on Outcomes | 281 |
Geographical Differences in Outcomes | 292 |
From Groups to Individuals | 309 |
Background and Current Methods | 121 |
A Model of Applied Health Systems Research | 140 |
Funding and Support | 155 |
Asking the Right Question Getting the Correct Answer | 167 |
The Integration of Evidence Based Medicine and Health Services Research in the ICU | 185 |
Using Systematic Reviews to Inform Decision Makers | 198 |
Quality Management in the ICU | 321 |
Translating Evidence into Practice | 336 |
Creating and Sustaining Change | 357 |
375 | |
Other editions - View all
Evaluating Critical Care: Using Health Services Research to Improve Quality William J. Sibbald,Julian F. Bion No preview available - 2002 |
Common terms and phrases
acute physiology analysis APACHE APACHE II approach assessment bias cardiac Clin clinical trial clinicians compared comparison Cook DJ Crit Critical Care Medicine critically ill patients database decision makers effect Engl evaluation evidence evidence-based evidence-based medicine example factors guidelines health services research healthcare hospital mortality HRQL ICU admission ICU stay impact implementation intensive care medicine intensive care unit intensivist intervention JAMA Knaus lead time bias Lemeshow length of stay mechanical ventilation ment meta-analyses methods models monitoring mortality rate multicenter nosocomial infection nursing organ dysfunction organ failure outcome measures performance physicians physiological potential practice predicted mortality prognostic randomized trials RCTs respiratory resuscitation risk SAPS SAPS II scoring systems semirecumbency sepsis septic shock severity of illness specific strategies surgery surgical survival systematic reviews therapeutic therapy tion trauma treatment validity variables Wagner DP