Quality Indicators: The Use of Metrics in Critical Care Medicine
The healthcare landscape is undergoing significant changes. An important movement toward value-based payments has heightened the focus on quality and cost. The intensive care unit (ICU) is characterized by high acuity, high resource utilization, and unwanted variability in the application of evidence-based treatments. These characteristics make the ICU a prime target for improvement programs focused on quality and safety. In this chapter, we discuss the basic paradigm of value in healthcare based on the relationship of quality and cost. We review the three domains utilized to assess quality in healthcare (structure, process, and outcome). In addition, we examine the essential characteristics required for good quality metrics in the ICU. A good quality metric in critical care should be important, valid, reliable, responsive, interpretable, and feasible. Factors to consider in assuring success when implementing quality metrics in the ICU include clear purpose, inclusion of the multidisciplinary team, and a structured approach to setting priorities. In the chapter, we review examples of quality metrics that meet these requirements and are specific to the ICU. Creating surrogates and overinterpretation of results falling in the trap of the law of small numbers are potential pitfalls to avoid. Critical care leaders must understand these fundamental principles in order to successfully utilize quality metrics and accurately assess quality of care and most importantly to create value for our patients.
KeywordsValue Quality Safety Metrics Intensive care unit
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