Quality assessement in lntensive Care Medicine
Keywords:
quality assessement, quality improvement, Intensive CareAbstract
The techniques of quality assessement and quality improvement are not new in the business world. However, their application to medicine has been delayed and amateurish by the medical professionals and entities involved.
The evaluation of our attitudes, procedures and results, when we aim at attaining better quality of care, has been until now imprecise, incidental and intuitive. It can and should be precise, systematic and rigorous. For that purpose, it is necessary to use a common language, which presupposes an in-depth knowledge ofthe various deflnitions pertaining to this matter.
The authors present and discuss the more frequently used terminology, comment on the process of quality evaluation and quality improvement in medicine, when focusing on the targets and beneftts. Finally, the applicabillty of this global approach to intensive care medicine in the 90's is discussed.
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Reis Miranda D, Gyldmark M. Evaluating aned understanding of costs in the intensive care unit. ln: Ryan DW, ed. Current practice in critical illness. London: Charman & Hall, 1996:129-149.
Thijs LG, Memhers of the Task Force of the Eurorean Society of Intensive Care Medicine. Continuous quality imrpovement in the ICU: general guidelines. lntensive Care Med 1997;23:125-127.
American Medical Association Council of Medical Service. Quality of care. JAMA 1984;256:1032-1034.
Lohr KN. Medicare: a strategy for quality assurance. Washington, D.C.: National Academy Press, 1990
Lomas J. Quality assurance and effectiveness in health care: an overview. Qual Assur Health Care 1990;2:5-12.
New York State Department of Health. Coronary artery hyrass surgery in New York State, 1990-1992. Albany: New York State Department of Health, 1993.
Chassin MR. Improving the quality of care. N Engl J Med 1996;335:1060-1063.
Blumenthal D. Origins of the quality-of-care debate. N Engl J Med 1996;335:1146-1149.
Cook D, Ellrodt G. The potential role of clinical practice guidelines in the ICU. Curr Opin Crit Care 1996;2:326-330.
Donahedian A. Continuity and change in the quest of quality. Clin Perform Qual Health Care 1993;1:9-16.
Organization anel management of Intensive Care: a prospective study in 12 European countries. Reis Miranda D, Ryan DW, Schaufeli WB, Fidl:r V, eds. Berlin Heidelberg: Springer-Verlag, 1997.
Carlet J. Quality assessment of intensive care units. Curr Opin Crit Care 1992:319-325.
Brook RH, McGlynn EA, Cleary PD. Measuring quality of care. N Engl J Med 19%;335:966-970.
Donahedian A. The seven pillars of quality. Arch Pathol Lab Med 1990;114:1115-1118.
Con ors AF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ili patients. JAMA 1996;276:889-897.
Kalh PE, Miller DH. Utilization strategies for intensive care unit . JAMA 1989;261:2389-2395.
Rogers RM, Weiler C, Ruppenthal B. Impact of the respiratory intensive care unit in survival of patients with acute respiratory failure. Chest 1972;62:94-97.
Skidmore FD. A review of 460 patients admitted to the intensive therapy unit in a general hospital. Br J Surg 1973;60:1-16.
Feller I, Tholen D, Cornell RG. Improvements in bum care. JAMA 1980;244:2074-2078.
Griner PF. Treatment of acute pulmonary edema: conventional or intensive care? Ann Intern Med 1972;77:501-506.
Piper KW, Griner PF. Suicide attempts with dmg overdose: ou comes of intensive care vs. conventional floor care. Arch Intern Med 1974;134:703-706.
Hook EW, Horton CA, Schaberg DR. Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA 1983;249:1055-1057.
Knaus WA, Draper EA, Wagner DP, ZimmermanJE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.
Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS li) based on a European / North American multicenter study. JAMA 1993;270:2957-2%3.
Teres D, Lemeshow S. Using severity measures to describe high performance intensive care units. Crit Care Clin 1993;9:543-554.
Jencks SF, Daley J, Draper D, Thomas N, Lenhart G, Walker J. Interpreting hospital data: the role of clinical risk adjustment.
Predicting hospital mortality for Medicare patients: a method for patients with stroke, pneumonia, myocardial in farction, and congestive hearth failure. JAMA 1988;260:3617- 3624.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centers. Ann lntern Med 1986;104:410-418.
Berwick D. Continuous improvement as an ideal in health care. N Engl J Med 1989;320:53-56.
Suter P, Armagandis A, Beaufils F, et al. Predicting outcome in ICU patients: consensus conference organized by the ESI CM and the SRLF. Intensive Care Med 1994;20:390-397.
8lumenthal D. Quality of care - what is it? N Eng! J Med 1996:335:891-894.
Fowkes FGR. Medical audit cycle. A review of methods and research in clinicai practice. Med Educ 1982;16:228-338.
Moreno R, Reis Miranda D, lapichino G. Variations in the utili sation of nursing manpower according to European areas. Intensive Care Med 1996;22:5304.
Moreno R, Reis Miranda D, Iapichino G. The efficiency of nursing manpower use in Europe. Intensive Care Med 1996:22:S304.
Wagner DP, Knaus WA, Draper EA. Identification of Iow-risk monitor admissions to medical-surgical ICUs. Chest 1987:92:423-428.
McClish DK, Powell SH. How well can physicians estimate mortality in a medical intensive care unit? Med Decis Making l989;9:125-132.
Wagner DP, Knaus WA, Draper EA, et al. Identification of Iow risk monitor patient within a medical-surgical !CU. Med Care 1983;21:425-433.
Zimmerman JE, Wagner DP, Knaus WA, Williams JF, Kolakowski D, Draper EA. The use of risk predactors to identify candidates for intermediate care unit . Implications for in tensive care unit utilization. Chest 1995;108:490-499.
ZimmermanJE, Wagner DP, Sun X, Knaus WA, Draper EA. Planning patient services for intermediate care units: insight based on care for intensive care unit Iow-risk monitor admissions. Crit Care Med 1996;24:1626-1632.
Strauss MJ, LoGerfo JP, Yeltatzie JA, Temkin N, Hudson LO. Rationing of intensive care unit services. An everyday occurrence. JAMA 1986;255:1143-1146.
Zimmerman JE, Wagner DP, Draper EA, Knaus WA. Improving intensive care unit discharge decisions: supplementary physician judgment with predictions of next day risk for life support. Crit Care Med 1994;22:1373-1384.
Civetta JM, Hudson-Civetta JA, Nelson LD. Evaluation of APACHE II for cost containment and quality assurance. Ann Surg 1990;212:266-276.
Atkinson·S, Bihari D, Smithies M, Daly K, Mason R, McColl I. Identification of futility in intensive care. Lancet 1994;344:1203-1206.
Cerra FB, Negro F, Abrams J. APACHE II score does not predict multiple organ failure or mortality in post-operative surgical patients. Arch Surg 1990 ;125:519-522.
Rapoport J, Teres D, Lemeshow S, AvruninJ S, Haber R. Explaining variability of cost using a severity of illness measure for ICU patient . Med Care 1990; 28:338-348.
Oye RK, Bellamy PF. Patterns of resource consumption in medical intensive care. Chest 1991;99:695-689.
Jacobs S, Arnold A, Clyburn PA, Willis BA. Toe Riyadh intensive care program applied to a mortality analysis of a teaching hospital intensive care unit. Anaesthesia 1992;47:775-780.
Murray L', Teasdale GM, Murray GD, et al. Does prediction of outcome alter patient management ? Lancet 1993;341:1487- 1491.
Veloso AB. Qualidade em medicina. Boletim Clinico Hospitais Civis de Lisboa 1996;50:13-15.
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