Division of Pulmonary and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Division of Cardiology, McGill University, Montreal, Quebec, Canada.
Int J Cardiol. 2018 Jun 1;260:219-225. doi: 10.1016/j.ijcard.2018.02.113. Epub 2018 Feb 28.
Quality indicators (QIs) are increasingly used in cardiovascular care as measures of performance but there is currently no consensus on indicators for the cardiovascular intensive care unit (CICU).
We searched Medline, CINAHL, EMBASE, and COCHRANE databases from inception until October 2016 and websites for organizations involved in quality measurement for QIs relevant to cardiovascular disease in an intensive or critical care setting. We surveyed 14 expert cardiac intensivist-administrators (7 European; 7 North American) on the importance and relevance of each indicator as a measure of CICU care quality using a scale of 1 (=lowest) to 10 (=highest). Indicators with a mean score ≥8/10 for both importance and relevance were included in the final set.
Overall, 108 QIs (70 process, 18 structural, 18 outcome, 1 patient engagement, and 1 covering multiple domains) were identified in 30 articles representing 23 agencies, organizations, and societies. Disease-specific QIs included myocardial infarction (n = 37), heart failure (n = 31), atrial fibrillation (n = 11), and cardiac rehabilitation (n = 1); general QIs represented about one-quarter (n = 28) of all measures. Fifteen QIs were selected for the final QI set: 7 process, 2 structural, and 6 outcome measures, including 6 general and 9 disease-specific measures. Outcome measures chosen to evaluate general CICU performance included overall CICU mortality, length of stay, and readmission rate.
Numerous QIs relevant to the CICU have been recommended by a variety of organizations. The indicators chosen by the cardiac intensivist-administrators could serve as a basis for future efforts to develop a standardized set of quality measures for the CICU.
质量指标（QIs）作为衡量绩效的手段，在心血管护理中越来越多地被使用，但目前对于心血管重症监护病房（CICU）的指标还没有共识。
我们从建库到 2016 年 10 月在 Medline、CINAHL、EMBASE 和 COCHRANE 数据库以及涉及质量测量的组织的网站上进行了搜索，以寻找与重症或危重症环境中的心血管疾病相关的 QIs。我们使用 1 到 10（最低到最高）的量表，对 14 位专家心脏重症医师-管理人员（7 位来自欧洲，7 位来自北美）进行了调查，了解每个指标作为 CICU 护理质量衡量标准的重要性和相关性。重要性和相关性的平均评分均≥8/10 的指标被纳入最终的指标集。
总体而言，在 30 篇代表 23 个机构、组织和协会的文章中确定了 108 个 QIs（70 个过程指标、18 个结构指标、18 个结果指标、1 个患者参与指标和 1 个涵盖多个领域的指标）。特定疾病的 QIs 包括心肌梗死（n=37）、心力衰竭（n=31）、心房颤动（n=11）和心脏康复（n=1）；一般 QIs 占所有措施的约四分之一（n=28）。最终 QI 集选择了 15 个 QIs：7 个过程指标、2 个结构指标和 6 个结果指标，包括 6 个一般指标和 9 个特定疾病指标。选择用于评估一般 CICU 表现的结果指标包括 CICU 总死亡率、住院时间和再入院率。
各种组织已经推荐了许多与 CICU 相关的 QIs。心脏重症医师-管理人员选择的指标可以作为未来为 CICU 制定标准化质量指标集的基础。
