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ISSN 2448-8909 (Print)

2009, Number 4

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Med Crit 2009; 23 (4)

Winner to Prize «Dr. Mario Shapiro»
Quality of medical care I mexican ICU´s. Multicenter

Sánchez VLD

Language: Spanish
References: 93
Page: 187-198
PDF size: 237.70 Kb.


ABSTRACT

Background: National Intensive Care units lack a system of performance evaluation. Our team has validated methodological tools and now we intend to use them to design it.
Objectives: To develop indicators of quality of care in the national ICU’s and set their critical limits.
Patients and methods: Design: Prospective cohort. Sites: 22 ICU’s. Period: 6 years. Patients: 15 years or older. Variables: Clinical, APACHE II, Brussels score and NEMS. Statistical analysis: Descriptive and graphics of correlation between indexes of clinical and economical performances.
Results: 11,681 patients were enrolled, 52.4% men. Mean age was 53.1 ± 18.8 years. APACHE II was 14.1 ± 6.9. SMR was 1.26. Remarkable indicators were longlength fast in 33.0%, MODS in 31.7%, long length of stay in 24.6%, dissatisfaction with the service in 23.5% and ARF in 21.5%. In the graphics of performance, government institutions showed an appropriate use of resources. Private institution showed lower mortality with less use of resources. Most of the centers (72.7%) had an acceptable relationship between both indexes.
Conclusions: Indicators of quality of care in Mexican ICU are described and two methods of evaluation are proposed.


REFERENCES

  1. Snider GL. Allocation of intensive care. The physician’s role. Am J Respir Crit Care Med 1994;150:575-580.

  2. Ayres SM. New study prepares Society of Critical Care Medicine to face health care reform. Crit Care Med 1993;21:175-177.

  3. Jaffin JH, Champion HR, Boulanger BR. Economic considerations. Crit Care Clin 1993;9:765-774.

  4. Jacobs P, Noseworthy TW. National estimates of intensive care utilization and costs: Canada and the United States. Crit Care Med 1990;18:1282-1286.

  5. Dragstad L, Qvist J. Epidemiology of intensive care. Int J Tech Assess Health Care 1992;8:395-407.

  6. Singer M, Myers S, Hall G, Cohen SL, Armstrong RF. The cost of intensive care: A comparison on one unit between 1988 and 1991. Int Care Med 1994;20:542-549.

  7. Oye RK, Bellamy PE. Patterns of resource consumption in medical intensive care. Chest 1991;99:685-689.

  8. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-Acute Physiology and Chronic Health Evaluation: A physiologically based classification system. Crit Care Med 1981;9:191-197.

  9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification. Crit Care Med 1985;13:818-829.

  10. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system: Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619-1636.

  11. Le Gall JR, Loirat P, Alperovich A, Glaser P, Granthil C, Mathieu D, et al. A Simplified Acute Physiology Score for ICU patients. Crit Care Med 1984;12:975-977.

  12. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2959-2963.

  13. Lemeshow S, Teres D, Pastides H, et al. Avrunin JS, Steingrub JS. A method for predicting survival and mortality of ICU patients using objectively derived weigths. Crit Care Med 1985;13:519-525.

  14. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993;270:2478-2486.

  15. Osler TM, Rogers FB, Glance LG, Cohen M, Rutledge M, Shackford SR. Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS. J Trauma 1998;45:234-237.

  16. Sánchez-Velázquez LD. Capacidad discriminativa y costo de los sistemas de calificación de la gravedad de la enfermedad en la Unidad de Terapia Intensiva. Rev Asoc Mex Med Crit Ter Inten 1999;13:100-104.

  17. Suter P, Armaganidis A, Beaufils F, Bonfill X, Burchardi H, Cook D, et al. Predicting outcome in ICU patients. Intensive Care Med 1994;20:390-397.

  18. Blumberg MS. Risk adjusting health care outcomes: a methodologic review. Medical Care Review 1986;43:351-393.

  19. Randolph AG, Guyatt GH, Carlet J. Understanding articles comparing outcomes among intensive care units to rate quality of care. Crit Care Med 1998;26:773-781.

  20. Knaus WA, Draper EA, Wagner DP, Zimmerman J. Prognosis in acute organ system failure. Ann Surg 1985;202: 685-692.

  21. Bernard GR, Doig G, Hudson LD, Lemeshow S, Marshall JC, Russell J, et al. Quantification of organ failure for clinical trials and clinical practice. Am J Respir Crit Care Med 1995;151:A323.

  22. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple Organ Dysfunction Score: A reliable descriptor of a complex clinical outcome. Crit Care Med 1995;23:1638-1652.

  23. Vincent JL, Moreno R, Takala J, Willatts S, De Mendoça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996;22:707-710.

  24. Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, et al. The Logistic Organ Dysfunction System. A New way to assess organ dysfunction in the intensive care unit. JAMA 1996;276:802-810.

  25. Jacobs S, Zuleika M, Mphansa T. The Multiple Organ Dysfunction Score as a descriptor of patient outcome in septic shock compared with two other scoring systems. Crit Care Med 1999;27:741-744.

  26. Sánchez-Velázquez LD, Reyes-Sánchez ME, D’Ector LDM, Villaseñor CC, Gonzalez GA, Magdalena PML, et al. Discrimination and calibration of four scoring systems in multiple organ dysfunction syndrome. A Mexican population multicenter study. Crit Care Med 2000;28(Suppl):A120.

  27. Chalfin DB. Analysis of cost-effectiveness in intensive care: An overview of methods and a review of applications to problems in critical care medicine. Curr Opin Anaesthesiol 1996;9:129-133.

  28. Spivack D. The high cost of acute health care: A review of escalating costs and limitations of such exposure in intensive care units. Am Rev Respir Dis 1987;136:1007-1011.

  29. Fair allocation of intensive care unit resources (ATS Board of Directors Position Statement). Am J Respir Crit Care Med 1997;156:1282-1301.

  30. Audit Commission. Critical to Success. Audit Commission, London. 1999.

  31. Miranda DR, Map R, de Rijk A, Schaufeli W, Iapichino G, TISS Working Group. Nursing activities score. Crit Care Med 2003;31:374-382.

  32. Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic Intervention Scoring System: A method for quantitative comparison of patient care. Crit Care Med 1974;2:57-60.

  33. Keene AR, Cullen DJ. Therapeutic Intervention Scoring System: Update 1983. Crit Care Med 1983;11:1-3.

  34. Slatyer MA, James OF, Moore PG, Leeder SR. Costs, severity of illness and outcome in intensive care. Anaesth Intensive Care 1986;14:381-9.

  35. Miranda DR, Williams A, Loirat P. Management of Intensive Care: Guidelines for better use of resources. Dordrecht: KluwerAcademic Publishers, 1990.

  36. Mälstam J, Lind L. Therapeutic intervention scoring system (TISS) – a method for measuring workload and calculating costs in the ICU. Acta Anaesthesiol Scand 1992;36:758-763.

  37. Zimmerman JE, Wagner DP, Draper EA, Knaus WA. Improving intensive care unit discharge decisions: supplementing physician judgment with predictions of next day risk for life support. Crit Care Med 1994;22:1373-1384.

  38. Cullen DJ, Nemeskal AR, Zaslavsky AM. Intermediate TISS: A new Therapeutic Intervention Scoring System for non-ICU patients. Crit Care Med 1994;22:1406-1411.

  39. Miranda DR, Rijk A, Schaufeli W. Simplified Therapeutic Intervention Scoring System. The TISS-28 items – Results from a multicenter study. Crit Care Med 1996;24:64-73.

  40. Moreno R, Morais P. Validation of the simplified therapeutic intervention scoring system on an independent database. Intensive Care Med 1997;23:640-644.

  41. Irone M, Bolgan I. The Nine Equivalents of Nursing Man-power Use Score (NEMS): A tool for organizing and managing ICUs. Intensive Care Med 2002;28(Suppl):S159.

  42. Miranda DR, Moreno R, Iapichino G. Nine Equivalents of Nursing Manpower Use Score (NEMS). Intensive Care Med 1997;23:760-765.

  43. Iapichino G, Radrizzani D, Bertolini G, Ferla L, Pasetti G, Pezzi A, et al. Daily classification of the level of care. A method to describe clinical course of illness, use of resources and quality of intensive care assistance. Intensive Care Med 2001;27:131-136.

  44. Sánchez-Velázquez LD, Reyes SME, D’Ector LDM, Villaseñor CC, González AG, Magdaleno PMM, et al. Validation of the Simplified Therapeutic Intervention Scoring System (TISS-28) on an independent database in Mexican population. Crit Care Med 2000;28(Suppl):A120.

  45. Sánchez-Velázquez LD, Reyes SME. Correlation between two therapeutic intervention scoring methods and hospital costs. Crit Care Med 2002;12(Suppl):A181.

  46. Sánchez-Velázquez LD, Reyes SME, Aguilar PLF. NEMS as a surrogate marker of use of resources in the ICU. Crit Care Med 2003;31(Suppl):A37.

  47. Moreno R, Miranda R. Nursing staff in intensive care in Europe. The mismatch between planning and practice. Chest 1998;113:752-758.

  48. Weissman C. Factors influencing changes in surgical intensive care unit utilization. Crit Care Med 2000;28:1766-1771.

  49. Rapoport J, Teres D, Lemeshow S, Gehlbach S. A method for assessing the clinical performance and cost-effectiveness of intensive care units: A multicenter inception cohort study. Crit Care Med 1994;22:1385-1391.

  50. Cerón DU, Esponda PJ, Borbolla PM, Vázquez MJP. Rendimiento clínico y costo-efectividad de tres unidades de terapia intensiva mexicanas incluidas en la base de datos multicéntrica de terapia intensiva. Rev Asoc Mex Med Crit Ter Inten 2000;14:41-9.

  51. Estudio multicéntrico de un método para evaluar el desempeño clínico y la relación costo-efectividad en las unidades de terapia intensiva. XXX Congreso Anual de la Asociación Mexicana de Infectología y Microbiología Clínica, A.C. Mérida, Yuc. 08 Julio 2005.

  52. de la Cal MA, Cerda E. Surveillance and control of infections in the intensive care unit: rates, resistance, and carrier state. Enferm Infecc Microbiol Clin 1997;15(Suppl 3):47-52.

  53. Kollef MH, Shapiro SD, Fraser VJ, et al. Mechanical ventilation with or without 7-day circuit changes. Ann Intern Med 1995;123:168.

  54. Zack JE, Garrison T, Trovillion E, et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 2002;30:2407.

  55. Richards MJ, Edwards JR, Culver DH, et al. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999;27:887.

  56. Centers for Disease Control Hospital Infections Program: National Nosocomial Infection Survey semi-annual report, May 1996. World Wide Web. http//:cdc.gov/ncidod/diseases/hip/nnis/nnis0596.htm.

  57. Gerberding JL, Gaynes RP, Horan TC, et al. Semiannual report aggregated data from the National Nosocomial Infections Surveillance (NNIS) system December 1999 (corrected 3/29/2000). Available online at http//:www.cdc.gov/. Accessed March 14,2001.

  58. Schriber P, Frutiger A. Is the readmission rate a useful indicator of ICU quality? Intensive Care Med 2002;28(Suppl):S8.

  59. Efthimiou A, Argiriadou H, Tsaosi G, et al. Readmission to the ICU: A review of risk factors and outcomes. Intensive Care Med 2002;28(Suppl):S9.

  60. Burnsed B, Cheatham ML. Preventing readmission to the surgical intensive care unit. Intensive Care Med 2002;28 (Suppl):S142.

  61. García MP, López P, Eseverri C, et al. Quality of care in intensive care units. Retrospective study on long-term patients. Enferm Intensiva 1998;9:102-8.

  62. Cooper GS, Sirio CA, Rotondi AJ, et al. Are readmissions to the intensive care unit a useful measure of hospital performance? Med Care 1999;37:399.

  63. Chen LM, Martin CM, Keenan SP, et al. Patients readmitted to the intensive care unit during the same hospitalization: Clinical features and outcomes. Crit Care Med 1998;26:1834.

  64. Braga M, Gianotti L, Gentilini O, et al. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med 2001;29:242.

  65. Montejo JC, Grau T, Acosta J, et al. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients. Crit Care Med 2002;30:798.

  66. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: A systematic review. Crit Care Med 2001;29:2264.

  67. Taylor SJ, Fettes SB, Jewkes C, et al. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit Care Med 1999;27:2525.

  68. Kapadia FN, Bajan KB, Singh S, et al. Changing patterns of airway accidents in intubated ICU patients. Intensive Care Med 2001;27:296-300.

  69. Macmillan RR, Clark L. Quality of care: Re-intubation as a proxy measure on a general intensive care. Intensive Care Med 2002;28(Suppl):S44.

  70. Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 1999;27:340.

  71. Chevron V, Ménard JF, Richard JCh, et al. Unplanned extubation: Risk factors of development and predictive criteria for reintubation. Crit Care Med 1998;26:1049.

  72. Kapadia FN, Bajan KB, Raje KV. Airway accidents in intubated intensive care unit patients: An epidemiological study. Crit Care Med 2000;28:659.

  73. Carrión MI, Ayuso D, Marcos M, et al. Accidental removal of endotracheal and nasogastric tubes and intravascular catheters. Crit Care Med 2000;28:63.

  74. Goldhill DR, Summer A. Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 1998;26:1337.

  75. Markgraff R, Deutschinoff G, Pientka L, et al. Comparison of Acute Physiology and Chronic Health Evaluation (APACHE II and III), 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 2000;28:26.

  76. Black NA, Jenkinson C, Hayes JA, et al. Review of outcome measures used in adult critical care. Crit Care Med 2001;29:2119.

  77. Brooks R, Kerridge R, Hillman K, et al. Quality of life outcomes after intensive care. Comparison with a community group. Intensive Care Med 1997:23:581.

  78. Nielsen D, Sellgren J, Ricksten SE. Quality of life after cardiac surgery complicated by multiple organ failure. Crit Care Med 1997;25:52.

  79. Eddleston JM, White P, Guthrie E. Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 2000;28:2293.

  80. Rivera FR, Sánchez CJ, Vázquez MR. Validation of a quality of life questionnaire for critically ill patients. Intensive Care Med 1996;22:1034-42.

  81. Rivera FR, Sánchez CJJ, Abizanda CR, et al. Quality of life before intensive care unit admission and its influence on resource utilization and mortality rate. Crit Care Med 2001;29:1701.

  82. Wehler M, Martus P, Geise A, et al. Changes in quality of life after medical intensive care. Intensive Care Med 2001;27:154.

  83. Heyland DK, Guyatt G, Cook DJ, et al. Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Crit Care Med 1998;26:591.

  84. Mata GV, Fernandez RR, Carmona AG, et al. Factors related to quality of life 12 months after discharge from an intensive care unit. Crit Care Med 1992;20:1257.

  85. Harvey M (ed): Volunteers in the Critical Care Waiting Room. Anaheim, CA, Society of Critical Care Medicine, 1993:79-80.

  86. Johnson D, Wilson M, Cavanaugh B, et al. Measuring the ability to meet family needs in an intensive care unit. Crit Care Med 1998;26:266.

  87. Wasser T, Pasquale MA, Matchett SC, et al. Establishing reliability and validity of the Critical Care Family Satisfaction Survey. Crit Care Med 2001;29:192.

  88. Jastremski CA, Harvey M. Making changes to improve the intensive care unit experience for patients and their families. New Horiz 1998;6:99.

  89. Azoulay E, Chevret S, Leleu G, et al. Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000;28: 3044.

  90. Bijttebier P, Vanoost S, Delva D, et al. Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses. Intensive Care Med 2001;27:160.

  91. Sánchez-Velázquez LD, Reyes SME. Consequences of infection acquired in ICU:A case control study. Crit Care Med 2003;31(Suppl):A130.

  92. Sánchez-Velázquez LD, Reyes SME. Prolonged hospitalization in intensive care unit. Risk factors and consequences. Crit Care Med 2002;12(Suppl):A184.

  93. Ponce de León RS, Molinar RF, Domínguez ChG, et al. Prevalence of infections in intensive care units in Mexico: A multicenter study. Crit Care Med 2000;28:1316.




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