To evaluate critical care services, outcome data must be collected and then compared to a performance benchmark or standard. The outcomes that are examined include mortality, complication rates, hospital and ICU length of stay, staffing level, or the use of treatment resources. A simple comparison of these outcomes, however, is frequently unsatisfactory because the characteristics of patients treated in different ICUs are not the same. In addition, the ICUs that are compared will often differ because of variations in hospital referral patterns, teaching status, and location. To meaningfully evaluate ICU performance, therefore, data comparisons must be adjusted for variations in both patient and hospital characteristics.
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Keywords
- Hospital Mortality
- Interobserver Reliability
- Glasgow Coma Score
- Simplified Acute Physiology Score
- Lead Time Bias
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Carson SS, Stocking C, Podsadecki T, et al (1996) Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of “open” and “closed” formats. JAMA 276:322–328
Manthous CA, Amoateng YA, Al-Kharrat T, et al (1997) Effects of a medical intensivist on patient care in a community teaching hospital. Mayo Clin Proc 72:391–399
Engleman RM (1996) Mechanisms to reduce hospital stays. Ann Thorac Surg 61: S26–S29
Cheng DCH, Karske J, Peniston C, et al (1996) Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. Anesthesiology 85:1300–1310
Baker SP, O’Neil B, Haddun W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196
Feller I, Tholen D, Cornell RG (1980) Improvements in burn care, 1965 to 1979. JAMA 244:2074–2078
Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: a practical scale. Lancet ii: 81–84
Siegel JH, Goldwyn RM, Friedman HP (1971) Patterns and processes in the evaluation of human septic shock. Surgery 70:232–240
Shoemaker WP, Chang P, Czer L (1979) Cardiovascular monitoring in post-operative patients. Crit Care Med 7: 237–241
Teres D, Brown RB, Lemeshow S. (1982) Predicting mortality of intensive care unit patients: the importance of coma. Crit Care Med 10: 86–94
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) APACHE — acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9: 591–597
Knaus WA, Draper EA, Wagner DP, et al (1982) Evaluating outcome from intensive care: a preliminary multihospital comparison. Crit Care Med 10:491–496
Knaus WA, LeGall JR, Wagner DP, et al (1982) A comparison of intensive care in the U.S.A. and France. Lancet ii: 642–646
Wagner DP, Draper EA, Abizanda-Campos R, et al (1984) Initial international use of APACHE an acute severity of disease measure. Med Decis Making 4: 297–313
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II — a severity of disease classification system. Crit Care Med 13: 818–829
Le Gall JR, Loirat P, Alperovitch A, et al (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12: 975–977
Lemeshow S, Teres D, Pastides H, Avrunin JS, Gage RW (1985) A method for predicting survival and mortality of ICU patients using objectively derived weights. Crit Care Med 13: 519–525
Escarce JJ, Kelly MA (1990) Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score. JAMA 264:2389–2394
Borlase BC, Baxter JK, Kenney PR, Forse RA, Benotti PN, Blackburn GL (1991) Elective intra-hospital admissions versus acute interhospital transfers to a surgical intensive care unit: cost and outcome prediction. J Trauma. 31: 915–919
Dragsted L, Jorgenson J, Jensen NH, et al (1989) Interhospital comparisons of patient outcome from intensive care: importance of lead time bias. Crit Care Med 17:418–422
Rowan KM, Kerr JH, Major E, McPherson K, Vessey MD (1993) Intensive Care Society’s study in Britain and Ireland — II: Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. Br Med J 307:977–981
Jacobs S, Chang RWS, Lee B, Lee B (1988) Audit of intensive care: a 30 month experience using the APACHE II severity of disease classification system. Intensive Care Med 14:567–574
Sirio Ca, Tajimi K, Tase C, et al (1992) An initial comparison of intensive care in Japan and the United States. Crit Care Med 20:1207–1215
Knaus WA, Wagner DP, Draper EA, et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636.
Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rappoport J (1993) Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270: 2478–2486
Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
Sirio CA, Shepardson LB, Rotondi AJ, et al (1999) Community-wide assessment of intensive care outcomes using a physiologically based prognostic measure. Chest 115:793–801
Zimmerman JE, Wagner DP, Draper EA, Wright L, Alzola C, Knaus WA (1998) Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database. Crit Care Med 26:1317–1326
Pappachan JV, Millar B, Bennett D, Smith GB (1999) Comparison of outcome from intensive care admission after adjustment for case mix by the APACHE III prognostic system. Chest 115:802–810
Beck DH, Taylor BL, Millar B, Smith GB (1997) Prediction of outcome from intensive care: a prospective cohort study comparing acute physiology and chronic health evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 25:9–15
Bastos PG, Sun X, Wagner DP, Knaus WA, Zimmerman JE, The Brazil APACHE III Study Group (1996) Application of the APACHE III prognostic system in Brazilian intensive care units: a prospective multicenter study. Intensive Care Med 22:564–570
Markgraf R, Deutschinoff G, Pientka L, Schölten T (2000) Comparison of acute physiology and chronic health evaluation (APACHE II and III) and simplified acute physiology score (SAPS II): a prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit. Crit Care Med 28:26–33
Apolone G, Bertolini G, D’Amico R, et al (1996) The performance of SAPS II in a cohort of patients admitted to 99 Italian ICUs: results from GiViTI. Intensive Care Med 22:1368–1378
Moreno R, Morais P (1997) Outcome prediction in intensive care: results of a prospective, multicenter, Portuguese study. Intensive Care Med 23:177–186
Metnitz PGH, Valentin A, Vesely H, et al (1999) Prognostic performance and customization of the SAPS II: results of a multicenter Austrian study. Intensive Care Med 25:192–197
Moreno R, Miranda DR, Fidler V, Schilfgaarde RV (1998) Evaluation of two outcome prediction models on an independent database. Crit Care Med 26:50–61
Nouira S, Roupie E, El Atrouss S, et al (1998) Intensive care use in a developing country: a comparison between a Tunisian and a French unit. Intensive Care Med 24:1144–1151
Nouira S, Belghith M, Elatrous S, et al (1998) Predictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units. Crit Care Med 26:852–859
Vanderschuern S, Weerdt A, Malbrain M, et al (2000) Thrombocytopenia and prognosis in intensive care. Crit Care Med 28:1871–1876
Hamel MB, Goldman L, Teno J, et al (1995) Identification of comatose patients at high risk for death or severe disability. JAMA 273:1842–1848
Knaus WA, Wagner DP, Zimmerman JE, Draper EA. (1993) Variations in mortality and length of stay in intensive care units. Ann Intern Med 118:753–761
Borlase BC, Baxter JK, Benotti PN, et al (1991) Surgical intensive care unit resource use in a specialty referral hospital: I. Predictors of early death and cost implications. Surgery 109:687–693
Porath A, Eldar N, Harman-Bohem I, Gurman G (1994) Evaluation of the APACHE II scoring system in an Israeli intensive care unit. Isr J Med Sci 30:514–520
Boyd O, Grounds RM (1993) Physiological scoring systems and audit. Lancet 341:1573–1574
Goldhill DR Sumner A (1998) Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 26:1337–1345
Seneff MG, Wagner DP, Thompson D, Honeycutt C, Silver M (2000) The impact of long term actue care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation. Crit Care Med 28: 342–350
Jayes RL, Zimmerman JE, Wagner DP, Knaus WA (1996) Variations in the use of do-not resuscitate orders in ICUs. Chest 110:1332–1339
Pendergrast TJ, Luce JM (1997) Increasing incidence of witholding and withdrawal of life support for the critically ill. Am J Respir Crit Care 155:15–20
Egol A, Willmitch B (1998) Witholding and withdrawing care affects severity adjusted outcome data. Crit Care Med 26:A25 (Abst)
Zhu BP, Lemeshow S, Hosmer DW, Klar J, Avrunin J, Teres D (1996) Factors affecting the performance of the models in the mortality probability model II system and strategies of customization: a simulation study. Crit Care Med 24:57–63
Teres D, Lemeshow S (1999) When to customize a severity model. Intensive Care Med 25:140–142
Justice AC, Covinsky KE, Berlin JA (1999) Assessing the generalizability of prognostic information. Ann Intern Med 130:515–524
Chen LM, Martin CM, Morrison TL, Sibbald WJ (1999) Interobserver variability in data collection of the APACHE II score in teaching and community hospitals. Crit Care Med 27:1999–2004
Holt AW, Bury LK, Bersten AD, Skowronski GA, Vedig AE (1992) Prospective evaluation of residents and nurses as severity score data collectors. Crit Care Med 20:16898–1691
Rosenthal GE, Harper DL (1994) Cleveland health quality choice: a model for collaborative community based outcomes assessment. J Comm J Qual Improv 20:425–442
Langham J, Goldfrad C, Rowan K (1998) Can case mix adjustment methods be replicated directly from the publication. Intensive Care Med 24 (Suppl 1): S23 (Abst)
Bosman RJ, Oudemans van Straaten HM, Zandstra DF (1998) The use of intensive care information system alters outcome prediction. Intensive Care Med 24:953–958
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Zimmerman, J.E., Draper, E.A., Wagner, D.P. (2002). Comparing ICU Populations: Background and Current Methods. In: Sibbald, W.J., Bion, J.F. (eds) Evaluating Critical Care. Update in Intensive Care Medicine, vol 35. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56719-3_9
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