Download Evaluating Critical Care: Using Health Services Research to by J. F. Bion, W. J. Sibbald (auth.), William J. Sibbald MD, PDF

By J. F. Bion, W. J. Sibbald (auth.), William J. Sibbald MD, FRCPC, FCCHSE, Julian F. Bion FRCP, FRCA, MD (eds.)

Measuring the standard of a posh carrier like severe care that mixes the top expertise with the main intimate worrying is a problem. lately, con­ sumers, clinicians, and payers have asked extra formal exams and comparisons of the standard and prices of treatment [2). Donabedian [1) professional­ posed a framework for brooding about the standard of therapy that separates caliber into 3 parts: constitution, method, and end result. An instructive analogy for knowing this framework is to visualize a nutrients critic comparing the standard of a cafe. The critic may touch upon the ornament and lights ofthe eating place, how shut the tables are to one another, the level ofthe wine checklist and the place the chef educated. those are all reviews of the eating place constitution. furthermore, the critic could touch upon even if the provider used to be courteous and well timed - measures of strategy. eventually, the critic may possibly touch upon results like shopper delight or meals poisoning. equally, to a overall healthiness care critic, constitution is the actual and human assets used to carry medi­ cal care. tactics are the particular remedies provided to sufferers. Finally,outcomes are what occurs to sufferers, for instance, mortality, caliber of life,and satisfac­ tion with care (Table 1). there's a debate approximately which of those measurements is an important degree of quality.

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N Engl J Med 330:183-187 44. Mitchell-DiCenso A, Guyatt G, Marrin M, et al (1996) A controlled trial of nurse practitioners in neonatal intensive care. Pediatrics 98: 1143-1148 45. Dubaybo BA, Samson MK, Carlson RW (1991) The role of physician-assistants in critical care units. Chest 99:89-91 46. Pawloski SJ, Kersh PL (1992) Therapeutic heparin monitoring service in a small community hospital. Hosp Pharm 27:703-706,723 47. Dasgupta A, Rice R, Mascha E, Litaker D, Stoller JK (1999) Four-year experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation.

What is done? Our information about the impact of specific ICU processes on patient outcomes comes from applying the above tools and concepts within three major types of studies, randomized controlled trials (RCTs), meta-analysis of randomized trials, and prospective observational studies. The overall conclusion from these studies is that specific components of ICU processes appear to be closely associated with patient outcomes. In most cases, however, they have not demonstrated patient benefit but have suggested and, in some cases, concluded that there is patient harm.

Several investigators have developed explicit survey tools to measure these variables [8-10]. There is a limited number of studies describing lCU structure and its relationship to outcome. Four large studies deserve special mention because they compose most of the available data. Shortell, Zimmerman and their colleagues were involved with a number of studies using the APACHE database [8, 10, 11]. D. Rubenfeld the US and Europe. In 1991, Groeger and colleagues surveyed ICU medical directors and used American Hospital Association data to describe ICUs in the US [12].

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