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.
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DOI：
10.1186/s40560-021-00556-6
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发表时间：
2021-08-05
影响因子：
7.1
通讯作者：
Beane A
中科院分区：
文献类型：
--
作者：
Jawad I;Rashan S;Sigera C;Salluh J;Dondorp AM;Haniffa R;Beane A
危重病后的过高发病率和死亡率越来越多地归因于由于复杂的 ICU 管理而发生的潜在可避免的并发症（Berenholtz 等人，J Crit Care 17:1-2, 2002；De Vos 等人，J Crit Care 22:267-74, 2007；Zimmerman J Crit Care 1:12-5, 2002）。通过电子健康记录 (EHR) 或登记对质量指标 (QI) 进行常规测量越来越多地用于基准护理和评估改善干预措施。然而，现有的重症监护质量指标几乎完全来自高收入医疗系统中相对狭窄的 ICU 患者子集。本次范围审查的目的是系统地回顾有关评估重症监护的 QI 的文献，识别 QI，绘制其定义、证据基础，并描述测量的差异以及报告的实施优势和挑战。我们检索了 MEDLINE、EMBASE、CINAHL 和 Cochrane 图书馆，从最早的可用日期一直到 2019 年 1 月。为了提高搜索的敏感性，我们审查了灰色文献和参考文献列表。最低纳入标准是对一个或多个 QI 的描述，旨在评估通过注册平台或适用于护理质量监测的 EHR 捕获的 ICU 患者护理情况。搜索发现 4780 次引用。摘要审查共检索到全文 276 篇，其中 123 篇被接受。使用高质量卫生系统 (HQSS) 框架提出的医疗保健质量的三个组成部分对 ICU 中的 51 个独特的 QI 进行分类。最常见的不良事件包括医院获得性感染（13.7%）、医院流程（54.9%）和结果（31.4%）。患者报告的结果 QI 占比不到 6%。 35.7% 的文章描述了实施 QI 的障碍，分为操作障碍（51%）和可接受性障碍（49%）。尽管 ICU 护理具有复杂性和风险，但仅使用了少量的操作指标。未来质量指标的选择将受益于利益相关者驱动的方法，即患者和社区的价值观以及医疗保健提供者认为的可采取行动的改进的优先事项被优先考虑，并包括更加注重衡量可区分的护理过程。在线版本包含可在 10.1186/s40560-021-00556-6 获取的补充材料。
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. 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. 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%). 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. The online version contains supplementary material available at 10.1186/s40560-021-00556-6.
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影响因子：
4.5
作者：
Ahern, John W.;Alston, W. Kemper
通讯作者：
Alston, W. Kemper
影响因子：
--
作者：
Aryal D;Beane A;Dondorp AM;Green C;Haniffa R;Hashmi M;Jayakumar D;Marshall JC;McArthur CJ;Murthy S;Webb SA;Acharya SP;Ishani PGP;Jawad I;Khanal S;Koirala K;Luitel S;Pabasara U;Paneru HR;Kumar A;Patel SS;Ramakrishnan N;Salahuddin N;Shaikh M;Tolppa T;Udayanga I;Umrani Z
通讯作者：
Umrani Z
影响因子：
8.8
作者：
Bouadma, Lila;Sonneville, Romain;Timsit, Jean-Francois
通讯作者：
Timsit, Jean-Francois
影响因子：
3.1
作者：
Anesi, George L.;Gabler, Nicole B.;Wise, Robert D.
通讯作者：
Wise, Robert D.
影响因子：
168.9
作者：
Berlin, JA
通讯作者：
Berlin, JA