The intensive care unit (ICU) is the highest mortality place in any hospital and is one of the sites in which patient safety deficiencies are most common. For these reasons, the JCAHO, the NQF, and the Leapfrog Group are considering requiring or recommending ICU performance reporting. Despite the evidence of variation in care and outcome and the interest of policymakers, little is known about how to evaluate ICU performance. There have been no prior attempts to determine whether, using existing risk adjustment models, an excess of observed over expected mortality is an indicator of patient safety deficiencies in processes of care of simply reflects unmeasured clinical determinants of severity. It also is unknown whether structural variable that are associated the lower risk-adjusted mortality are actually associated with better process of reflect the influence of unmeasured confounders. In this project, we will build on existing research about evaluation of structure, process, and outcome in the ICU with the following objectives: 1) to determine the extent to which mortality reports identify hospital with high rates of errors in processes of care, 2) to evaluate the relationship between structure and processes of care and 3) to assess the extent to which provision of patient safety performance data can stimulate improvement. The central hypotheses underlying this work are that 1) risk adjusted mortality rates and structural variables are valid indicators of deficiencies in processes of care that pose patient safety threats, and 2) that these indicators can be used to drive improvements in outcomes. We will build on the existing 46 hospital CALICO network-members of which currently collect the detailed clinical data required to calculate all extant ICU mortality risk-adjustment models on their ICU patients-to create a more complete picture of ICU care than ever previously available for a hospital sample of this size. We will accomplish the goals of this project by performing chart abstractions to assess processes of care at CALICO hospitals and ICU surveys to assess structure, than linking existing mortality data to processes and the structural survey data to processes. We will then give participating hospitals feedback about their structure, processes, and outcomes and repeat our performance evaluation to assess change. The lessons of this project will help policy makers decide what how to measure and improve patient safety in the ICU.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS013919-02
Application #
6799549
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Zhan, Chunliu
Project Start
2003-09-30
Project End
2007-09-29
Budget Start
2004-09-30
Budget End
2005-09-29
Support Year
2
Fiscal Year
2004
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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Vasilevskis, Eduard E; Kuzniewicz, Michael W; Cason, Brian A et al. (2011) Predictors of early postdischarge mortality in critically ill patients: a retrospective cohort study from the California Intensive Care Outcomes project. J Crit Care 26:65-75
Vasilevskis, Eduard E; Kuzniewicz, Michael W; Dean, Mitzi L et al. (2009) Relationship between discharge practices and intensive care unit in-hospital mortality performance: evidence of a discharge bias. Med Care 47:803-12
Vasilevskis, Eduard E; Kuzniewicz, Michael W; Cason, Brian A et al. (2009) Mortality probability model III and simplified acute physiology score II: assessing their value in predicting length of stay and comparison to APACHE IV. Chest 136:89-101
Kuzniewicz, Michael W; Vasilevskis, Eduard E; Lane, Rondall et al. (2008) Variation in ICU risk-adjusted mortality: impact of methods of assessment and potential confounders. Chest 133:1319-27