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Development and 2025 re-evaluation of a Japanese quality indicator set for adult intensive care: a modified RAND/UCLA
Junji Kumasawa1,2, Hiroshi Okamoto3, Takaki Naito4
1Department of Critical Care Medicine, Sakai City Medical Cente, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai, Osaka, 593-8304, Japan. jkumakumakuma@hotmail.com.
Journal of Intensive Care
|February 10, 2026
Summary
A 2025 re-evaluation updated Japan's intensive care unit (ICU) quality indicators (QIs), ensuring relevance for continuous quality improvement and national benchmarking in adult ICUs.
Area of Science:
- Critical Care Medicine
- Healthcare Quality Improvement
- Health Services Research
Background:
- Established a comprehensive, evidence-based set of quality indicators (QIs) for adult intensive care units (ICUs) in Japan.
- Recognized the need for periodic updates to QIs due to evolving evidence and practice in critical care.
- Initiated a formal re-evaluation in 2025 to confirm the validity and update the core Japanese ICU QI set developed in 2017-2018.
Purpose of the Study:
- To develop and update a feasible, contextually adapted set of quality indicators for Japanese intensive care units.
- To confirm the current validity and relevance of existing ICU quality indicators.
- To establish a foundation for national benchmarking and continuous quality improvement in Japanese ICUs.
Main Methods:
- Employed a modified RAND/UCLA appropriateness method involving a multidisciplinary expert panel.
- Conducted systematic literature reviews and analyzed major clinical guidelines to generate candidate quality indicators.
- Utilized a three-round rating and consensus process, including face-to-face meetings, to refine and finalize the quality indicator set.
Main Results:
- An initial set of 44 candidate quality indicators was identified.
- The 2018 consensus process resulted in a set of 38 quality indicators (13 structure, 10 process, 15 outcome).
- The 2025 re-evaluation confirmed 37 indicators as appropriate, reclassified one as uncertain, and added one new appropriate indicator, maintaining a core set of 38 indicators.
Conclusions:
- A rigorous methodology was used to develop and update a feasible and contextually relevant Japanese ICU QI set.
- The updated core set of 38 quality indicators provides a robust foundation for quality improvement initiatives.
- The finalized quality indicators are deemed appropriate and relevant for the Japanese ICU setting, supporting national benchmarking.
Keywords:
Administrative claims dataDelphi methodIntensive Care UnitQuality indicatorsQuality of careRANDMore Related Videos
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