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National Institute for Public Health and Environment

Naam van de presentator(en) | datum. Development and Evaluation of Quality Indicators in the Intensive Care Unit: Preliminary Results Maartje de Vos, Wilco C.Graafmans | 26 June 2006 Centre for prevention and health services research Email:maartje.de.vos@rivm.nl.

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National Institute for Public Health and Environment

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  1. Naam van de presentator(en) | datum Development and Evaluation of Quality Indicators in the Intensive Care Unit: Preliminary Results Maartje de Vos, Wilco C.Graafmans | 26 June 2006 Centre for prevention and health services research Email:maartje.de.vos@rivm.nl National Institute for Public Health and Environment

  2. Outline presentation • Background • Study methods • Results: selected set of quality indicators for ICU • Results: variation among ICUs

  3. Background • Growing need/expectation to measure quality of care in the Netherlands, e.g. at ICUs • Measurement by quality Indicators: screening tool to identify potential sub-optimal clinical care • Different types of indicators (Donabedian):structure, process, and outcome indicators • Learn and improve from indicators by comparing results with reference values and comparison among hospitals

  4. Objectives • Objectives: 1) to develop a set of quality indicators for the ICU and, 2) to evaluate the use of these indicators in a pilot study • Quality indicators for internal use, to stimulate improvement of quality of care at ICUs • Supported by the Dutch Health Care Inspectorate and the Association of Medical Specialists

  5. Development of indicators • Methods • Literature search: 50 indicators • Expert opinion:12 indicators • Working group: Dutch Society of Intensive Care (NVIC) • Selection based on relevance for quality, feasibility, and potential for improvement • By consensus among experts 12 indicators were selected

  6. Set of indicators Case mix age,gender • Structure • Intensivist availability • Nurse to patiënt ratio • Medication error prevention policy • Registration of patiënt/family satisfaction • Process • ICU lenght of stay • Duration of mechanical ventilation • Frequency of interclinical transport • Frequency 100% occupation • Glucose dysregulation • Outcome • Mortality • Incidence of severe decubitus • Frequency of unplanned extubation

  7. Pilot Study • Aim: • to evaluate the feasibility of the registration of the indicators • To obtain data for analyses • Methods • 18 ICUs • Registration during 6 months • Data collected in a national database (NICE) • Site visits, interviews • Questionnaire (time te register, workload and perceived validity and reliability)

  8. 46%< 30 min 17%> 60 min Pilot Study • Results (feasibility) • Time to register per day • 46% < 30 min • 37% 30-60 min • 17% > 60 min • Workload was acceptable for 86% of the respondents • Interclinical transport and unplanned extubation were the least reliable collected items • > 80% supported further implementation for 9 indicators Investment of time to register 37% 30-60

  9. Results (examples of crude data) • 7682 admissions, 31849 treatment days CONCEPT

  10. Conclusion • A set of 12 indicators was defined: 4 structure, 5 process and 3 outcome • Workload of registration was acceptable but computer assistance is necessary • Crude data of scores of indicators discriminate among hospitals • Future plans: • Adjusting the set for implementation • Analysis for interpretation and feed back • Research on case mix

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