What intensive care registries can teach us about outcomes

Abstract

Purpose of review Critical care registries are synonymous with measurement of outcomes following critical illness. Their ability to provide longitudinal data to enable benchmarking of outcomes for comparison within units over time, and between units, both regionally and nationally is a key part of the evaluation of quality of care and ICU performance as well as a better understanding of case-mix. This review aims to summarise literature on outcome measures currently being reported in registries internationally, describe the current strengths and challenges with interpreting existing outcomes and highlight areas where registries may help improve implementation and interpretation of both existing and new outcome measures. Recent findings Outcomes being widely reported through ICU registries include measures of survival, events of interest, patient reported outcomes and measures of resource utilisation (including cost). Despite its increasing adoption, challenges with quality of reporting of outcomes measures remain. Measures of short-term survival are feasible, but those requiring longer follow-ups are increasingly difficult to interpret given the evolving nature of critical care in the context of acute and chronic disease management. Furthermore, heterogeneity in patient populations and in healthcare organisations in different settings makes use of outcome measures for international benchmarking at best complex, requiring substantial advances in their definitions and implementation to support those seeking to improve patient care. Summary Digital registries could help overcome some of the current challenges with implementing and interpreting ICU outcome data through standardisation of reporting and harmonisation of data. In addition, ICU registries could be instrumental in enabling data for feedback as part of improvement in both patient centred outcomes and in service outcomes; notably resource utilisation and efficiency.

Development of a quality indicator set to measure and improve quality of ICU care in low- and middle-income countries

“…These indicators will be evaluated for feasibility of implementation, and for their ability to reliably measure associated outcomes. This study brings new perspectives to the ongoing discussion [ 11 , 18 , 25 ] regarding indicator selection for benchmarking ICUs internationally, and the potential implications that use of some indicators for pay for performance may be having on efforts to improve quality of care. This study adds to the existing international literature by providing much needed representation from previously under-represented ICU services and critical care populations in low- and middle-income health systems.…”

“…The use of registry-based data collection, the co-design of implementation processes and the use of feedback tools were identified as important strategies to overcome known barriers of feasibility and reliability of data collected [22][23][24][25]. Current measures of medium-long-term functional outcomes, whilst perceived as a priority, were considered poorly reflective of some social and lifestyle constructs for communities in Africa and Asia.…”

National ICU Registries as Enablers of Clinical Research and Quality Improvement

“…As a result of an aging population currently, CRQs show that in both high-income countries (HICs) and low-/middle-income countries (LMICs), the median age of ICU patients is, in several countries, above 70 years (17,45,46). Therefore, a better understanding of age, multimorbidity, and frailty (47) in the ICU has become a priority for intensivists, geriatricians, and policymakers (29)(30)(31)48).…”

“…locally generated data, ICUs could assess their performances by using risk-adjusted measures and compare their results through fair and validated benchmarking metrics with other ICUs contributing to the CQR (16,17). The accomplishment of these initiatives, coupled with the increasing adoption of information technology, resulted in a broad geographic expansion of CQRs (Fig.…”

“…The accomplishment of these initiatives, coupled with the increasing adoption of information technology, resulted in a broad geographic expansion of CQRs (Fig. 1 ESM, http://links.lww.com/CCM/H419) (16)(17)(18)(19)(20)(21)(22). A list of current ICU registries is provided on Table 1 ESM (http://links.lww.com/CCM/H419).…”