Kollef M H
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
New Horiz. 1998 Feb;6(1):91-8.
The impact of respiratory care practitioners on the outcomes of critically ill patients has not been examined in a systematic manner. This is in contrast to clinical investigations which have demonstrated the beneficial influence of specially trained critical care physicians and nurses on patient outcomes in the ICU setting. Outcomes research represents a method for the formal evaluation of various healthcare provider staffing patterns within the ICU. Specific patient outcomes including hospital mortality, respiratory complications, lengths of stay, and medical care costs can be used to determine the optimal ICU staffing strategy for respiratory care practitioners. Until recently, we have lacked good outcomes data for assessing the role of respiratory care practitioners in the ICU. Several barriers have contributed to this deficiency of data including a lack of funding, absence of a national research initiative aimed at this specific issue, and the paucity of clinical investigators in this area of study. Good outcomes research requires appropriate levels of funding, adequately trained and experienced clinical investigators from various disciplines (e.g., statistics, epidemiology, general medical sciences), and the support of both local and national organizations with an interest in respiratory care services and their impact on patient outcomes. To accomplish these research goals, an organized and dedicated approach must be developed based upon strong research proposals. This will allow advances to be made in the area of outcomes research as it relates to the role of respiratory care practitioners in the ICU. Similarly, the methods of outcomes research can be employed to better define the benefits and limitations of other ICU practices.
呼吸治疗从业者对重症患者治疗结果的影响尚未得到系统研究。这与临床研究形成对比，临床研究已证明经过专门培训的重症监护医生和护士对重症监护病房（ICU）患者的治疗结果具有有益影响。结果研究是一种正式评估ICU内各种医疗服务人员配置模式的方法。包括医院死亡率、呼吸并发症、住院时间和医疗费用在内的特定患者治疗结果可用于确定针对呼吸治疗从业者的最佳ICU人员配置策略。直到最近，我们仍缺乏用于评估呼吸治疗从业者在ICU中作用的良好治疗结果数据。造成这种数据缺乏的原因有几个，包括资金不足、缺乏针对这一特定问题的全国性研究计划，以及该研究领域临床研究人员的匮乏。良好的结果研究需要适当水平的资金、来自各个学科（如统计学、流行病学、普通医学）的训练有素且经验丰富的临床研究人员，以及对呼吸治疗服务及其对患者治疗结果影响感兴趣的地方和国家组织的支持。为实现这些研究目标，必须基于强有力的研究提案制定一种有组织、有针对性的方法。这将使与呼吸治疗从业者在ICU中作用相关的结果研究领域取得进展。同样，结果研究方法可用于更好地界定其他ICU实践的益处和局限性。
