Evaluating Critical Care

1. Front Matter

   Pages I-XIII

   PDF

2. Overview

   1. Front Matter

      Pages 1-1

      PDF

   2. Introduction — Critical Care: Problems, Boundaries and Outcomes

      • J. F. Bion, W. J. Sibbald

      Pages 3-5

   3. Health Services Research: A Domain where Disciplines and Decision Makers Meet

      • J. Lomas

      Pages 6-19

3. Methods of Measurement in Intensive Care

   1. Front Matter

      Pages 21-21

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   2. The Structure of Intensive Care

      • G. D. Rubenfeld

      Pages 23-40

   3. Process of Care Assessment and the Evaluation of Outcome from Intensive Care

      • W. A. Knaus

      Pages 41-50

   4. Severity of Illness

      • R. Moreno

      Pages 51-68

   5. Measuring Treatment Outcomes in Intensive Care: Mortality, Morbidity, and Organ Dysfunction

      • J. C. Marshall

      Pages 69-85

   6. Health-Related Quality of Life: During and Following Critical Care

      • D. J. Kutsogiannis, T. Noseworthy

      Pages 86-103

   7. Quality of Life and Longer Term Outcomes

      • S. A. Ridley

      Pages 104-118

4. Techniques for Acquiring Information

   1. Front Matter

      Pages 119-119

      PDF

   2. Comparing ICU Populations: Background and Current Methods

      • J. E. Zimmerman, E. A. Draper, D. P. Wagner

      Pages 121-139

   3. A Hospital-Wide System for Managing the Seriously Ill: A Model of Applied Health Systems Research

      • K. Hillman, A. Flabouris, M. Parr

      Pages 140-154

   4. Funding and Support

      • D. R. Miranda

      Pages 155-166

   5. Hypothesis Generation: Asking the Right Question, Getting the Correct Answer

      • D. C. Angus, P. Pronovost

      Pages 167-184

   6. The Integration of Evidence Based Medicine and Health Services Research in the ICU

      • D. J. Cook, M. K. Giacomini

      Pages 185-197

   7. Using Systematic Reviews to Inform Decision Makers

      • D. K. Heyland

      Pages 198-208

   8. Consensus Methods and Consumer Opinon

      • J. F. Bion

      Pages 209-221

   9. Benchmarking in the ICU: The Measurement of Costs and Outcome to Analyze Efficiency and Efficacy

      • H. Burchardi, M. Jegers, M. Goedee, J. U. Leititis

      Pages 222-243

Measuring the quality of a complex service like critical care that combines the highest technology with the most intimate caring is a challenge. Recently, con­ sumers, clinicians, and payers have requested more formal assessments and comparisons of the quality and costs of medical care [2). Donabedian [1) pro­ posed a framework for thinking about the quality of medical care that separates quality into three components: structure, process, and outcome. An instructive analogy for understanding this framework is to imagine a food critic evaluating the quality of a restaurant. The critic might comment on the decoration and lighting ofthe restaurant, how close the tables are to each other, the extent ofthe wine list and where the chef trained. These are all evaluations of the restaurant structure. In addition, the critic might comment on whether the service was courteous and timely - measures of process. Finally, the critic might comment on outcomes like customer satisfaction or food poisoning. Similarly, to a health care critic, structure is the physical and human resources used to deliver medi­ cal care. Processes are the actual treatments offered to patients. Finally,outcomes are what happens to patients, for example, mortality, quality of life,and satisfac­ tion with care (Table 1). There is a debate about which of these measurements is the most important measure of quality.

• care
• critical care
• development
• education
• evaluation
• health services
• health services research
• hospital
• intensive care
• medicine
• mortality
• organization
• outcomes
• patients
• research

• Critical Care, University of Toronto, Canada

  William J. Sibbald

• Department of Medicine, Sunnybrook and Women’s College, Health Sciences Centre, Toronto, Canada

  William J. Sibbald

• Department of Anesthesia and Intensive Care Medicine, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK

  Julian F. Bion

Policies and ethics