Valiani Sabira, Rigal Romain, Stelfox Henry T, Muscedere John, Martin Claudio M, Dodek Peter, Lamontagne François, Fowler Robert, Gheshmy Afshan, Cook Deborah J, Forster Alan J, Hébert Paul C
Affiliations: University of Ottawa (Valiani, Gheshmy), Ottawa, Ont.; Centre de Recherche du Centre hospitalier de l'Université de Montréal (Rigal), Montréal, Que.; Departments of Critical Care Medicine and Community Health Sciences (Stelfox), University of Calgary, Calgary, Alta.; Department of Medicine (Muscedere), Queen's University, Kingston, Ont.; Lawson Health Research Institute (Martin), London Health Sciences Centre, London, Ont.; Division of Critical Care Medicine and Centre for Health Evaluation & Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Centre de recherche clinique Étienne-Le Bel (Lamontagne), Université de Sherbrooke, Sherbrooke, Que.; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, Toronto, Ont.; Departments of Medicine and of Clinical Epidemiology and Biostatistics (Cook), McMaster University, Hamilton, Ont.; Department of Medicine (Forster), University of Ottawa; Clinical Epidemiology Program (Forster), Ottawa Hospital Research Institute, Ottawa, Ont.; Département de Médecine (Hébert), Centre hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Que.
CMAJ Open. 2017 Jun 21;5(2):E488-E495. doi: 10.9778/cmajo.20150139.
We performed a directed environmental scan to identify and categorize quality indicators unique to critical care that are reported by key stakeholder organizations.
We convened a panel of experts ( = 9) to identify key organizations that are focused on quality improvement or critical care, and reviewed their online publications and website content for quality indicators. We identified quality indicators specific to the care of critically ill adult patients and then categorized them according to the Donabedian and the Institute of Medicine frameworks. We also noted the organizations' rationale for selecting these indicators and their reported evidence base.
From 28 targeted organizations, we identified 222 quality indicators, 127 of which were unique. Of the 127 indicators, 63 (32.5%) were safety indicators and 61 (31.4%) were effectiveness indicators. The rationale for selecting quality indicators was supported by consensus for 58 (26.1%) of the 222 indicators and by published research evidence for 45 (20.3%); for 119 indicators (53.6%), the rationale was not reported or the reader was referred to other organizations' reports. Of the 127 unique quality indicators, 27 (21.2%) were accompanied by a formal grading of evidence, whereas for 52 (40.9%), no reference to evidence was provided.
There are many quality indicators related to critical care that are available in the public domain. However, owing to a paucity of rationale for selection, supporting evidence and results of implementation, it is not clear which indicators should be adopted for use.
我们进行了一项定向环境扫描，以识别和分类关键利益相关者组织报告的重症监护特有的质量指标。
我们召集了一个专家小组（n = 9），以确定专注于质量改进或重症监护的关键组织，并审查其在线出版物和网站内容中的质量指标。我们确定了针对重症成年患者护理的质量指标，然后根据唐纳贝迪安和医学研究所的框架对其进行分类。我们还记录了这些组织选择这些指标的理由及其报告的证据基础。
从28个目标组织中，我们确定了222个质量指标，其中127个是独特的。在这127个指标中，63个（32.5%）是安全指标，61个（31.4%）是有效性指标。222个指标中有58个（26.1%）选择质量指标的理由得到了共识支持，45个（20.3%）得到了已发表研究证据的支持；对于119个指标（53.6%），未报告理由或读者被指引参考其他组织的报告。在127个独特的质量指标中，27个（21.2%）附有正式的证据分级，而52个（40.9%）未提及证据。
公共领域有许多与重症监护相关的质量指标。然而，由于选择理由、支持证据和实施结果的匮乏，尚不清楚应采用哪些指标。
