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A new conceptual framework for ICU performance appraisal and improvement

Rotondi, AJ and Sirio, CA and Angus, DC and Pinsky, MR (2002) A new conceptual framework for ICU performance appraisal and improvement. Journal of Critical Care, 17 (1). 16 - 28. ISSN 0883-9441

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Purpose: This study examined the use of outcomes for the purposes of ICU evaluation and improvement. We reviewed the strengths and weaknesses of an outcomes-centered approach to intensive care unit (ICU) evaluation and present a more comprehensive conceptual framework for ICU evaluation and improvement. Materials and Methods: Data was collected from 2 sources: (1) a structured review of the literature, with relevant articles identified using Medline, and (2) 85 semistructured interviews of health care professionals (eg, physicians) and health care administrators (eg, chief executive officer). The interviewees came from 4 institutions: a 900-bed East Coast teaching medical center, a 600-bed East Coast teaching medical center, a 590-bed East Coast teaching medical center, and a 435-bed West Coast private community hospital. A nonrandomized, purposeful sample was used. Results: A conceptual framework for ICU evaluation is presented that identifies and defines 3 different types of variables: performance (eg, appropriateness of care, effectiveness of care), outcome (eg, resource use, mortality), and process (eg, timeliness of treatment, work environment). The framework emphasizes performance variables and the relationships between performance, outcome, and process of care variables, as a logical focus for ICU evaluation and improvement. Conclusions: Performance variables offer distinct advantages over outcome variables for ICU evaluation. Their use, however, will require additional development of current evaluation tools and methods. They provide the ability to identify the value an ICU adds to patient care in a hospital or to an episode of illness, and to evaluate integrated systems for providing care. Copyright 2002, Elsevier Science (USA). All rights reserved.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Rotondi, AJ
Sirio, CA
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 January 2002
Date Type: Publication
Journal or Publication Title: Journal of Critical Care
Volume: 17
Number: 1
Page Range: 16 - 28
DOI or Unique Handle: 10.1053/jcrc.2002.33033
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0883-9441
PubMed ID: 12040545
Date Deposited: 20 Mar 2012 15:54
Last Modified: 30 Jan 2020 16:55


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