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The association between outcome-based quality indicators for intensive care units
Ilona W M Verburg1, Evert de Jonge2, Niels Peek3
1Academic Medical Center, University of Amsterdam, Department: Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
Plos One
|June 14, 2018
Summary
Quality indicators for intensive care units (ICUs) like mortality and length of stay show no overall association. However, differing relationships exist between mortality and length of stay within specific patient risk groups, highlighting the need for subgroup analysis in ICU benchmarking.
Area of Science:
- Critical Care Medicine
- Health Services Research
Background:
- In-hospital mortality, ICU readmission, and ICU length of stay are key indicators for assessing intensive care unit (ICU) effectiveness.
- Benchmarking ICU performance often relies on these quantifiable quality indicators.
Purpose of the Study:
- To investigate associations between case-mix adjusted, outcome-based quality indicators in the general ICU population.
- To examine these associations within specific patient subgroups.
Main Methods:
- Analysis of data from all Dutch ICUs in 2015.
- Calculation of standardized mortality ratio (SMR), standardized readmission ratio (SRR), and standardized length of stay ratio (SLOSR).
- Assessment of associations using Pearson's correlation coefficients.
Main Results:
- No significant associations were found for the total ICU population.
- A positive, non-significant association between SMR and SLOSR was observed for low-mortality risk admissions (r = 0.25; p = 0.024).
- A negative association between SMR and SLOSR was found for high-mortality risk admissions (r = -0.49; p<0.001).
Conclusions:
- Overall, no association exists between ICU quality indicators at the population level.
- Differential associations between mortality and length of stay performance were identified within different patient risk strata.
- Benchmarking ICUs requires considering multiple outcome indicators and reporting quality for patient subgroups.
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