Evaluating Critical Care

Using Health Services Research to Improve Quality

  • William J. Sibbald
  • Julian F. Bion

Part of the Update in Intensive Care Medicine book series (volume 35)

Table of contents

  1. Front Matter
    Pages I-XIII
  2. Overview

  3. Methods of Measurement in Intensive Care

  4. Techniques for Acquiring Information

    1. Front Matter
      Pages 119-119
    2. J. E. Zimmerman, E. A. Draper, D. P. Wagner
      Pages 121-139
    3. D. R. Miranda
      Pages 155-166
    4. J. F. Bion
      Pages 209-221
    5. H. Burchardi, M. Jegers, M. Goedee, J. U. Leititis
      Pages 222-243
    6. A. R. Webb
      Pages 244-254
    7. M. Imhoff
      Pages 255-269
    8. J. L. Vincent, S. Brimioulle
      Pages 270-278
  5. Application and Interpretation: Using Data to Improve Outcomes

    1. Front Matter
      Pages 279-279
    2. J. B. Hall
      Pages 281-291
    3. L.G. G. Thijs
      Pages 292-308
    4. J. Carlet, L. Montuclard, M. Garrouste-Orgeas
      Pages 309-320
    5. W. J. Sibbald, G. K. Webster
      Pages 357-374
  6. Back Matter
    Pages 375-379

About this book


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

Editors and affiliations

  • William J. Sibbald
    • 1
    • 2
  • Julian F. Bion
    • 3
  1. 1.Critical CareUniversity of TorontoCanada
  2. 2.Department of Medicine, Sunnybrook and Women’s CollegeHealth Sciences CentreTorontoCanada
  3. 3.Department of Anesthesia and Intensive Care MedicineUniversity of Birmingham, Queen Elizabeth HospitalBirminghamUK

Bibliographic information

  • DOI
  • Copyright Information Springer-Verlag Berlin Heidelberg 2002
  • Publisher Name Springer, Berlin, Heidelberg
  • eBook Packages Springer Book Archive
  • Print ISBN 978-3-540-42606-6
  • Online ISBN 978-3-642-56719-3
  • Series Print ISSN 0933-6788
  • Buy this book on publisher's site