Key result
Risk Profile Management improves direct ICU comparisons over conventional single-point mortality estimates.
The Risk Profile Management method provides a superior approach to benchmarking ICU performance by accounting for varying levels of patient illness severity.
May refine ICU benchmarking; leaves open prospective validation before any practice change.
PURPOSE OF REVIEW: Benchmarking of the ICU was till last year based on the assumption that performance was independent of the severity of illness of the admitted patients. In the past years, this assumption has been challenged several times, but only last year a concrete method to evaluate the performance of individual ICUs through the calculation and visualization of risk profiles was proposed and experimentally tested in a cohort of 102 561 patients consecutively admitted to 77 ICUs in Austria, belonging to the Austrian Center of Documentation and Quality Assurance in Intensive Care Medicine. RECENT FINDINGS: The demonstration, although using the New Simplified Acute Physiology Score (SAPS II), is independent of the specific general outcome prediction model used. The method allows the computation of individual risk profiles for all ICUs in the data set under analysis and both the Hosmer-Lemeshow goodness-of-fit test statistics and the histogram of the corresponding P values demonstrated a good fit of the individual risk models. SUMMARY: The new method, the Risk Profile Management method, makes it possible to evaluate individual ICUs on the basis of the specific risk for patients to die compared with a reference sample over the whole spectrum of hospital mortality. This way, even ICUs operating with different levels of mean severity of illness of the admitted patients can be directly compared, giving a clear advantage over the use of the conventional single-point estimate of the overall observed-to-expected mortality ratio.
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Moreno et al. (2010) conducted a review in ICU admission (n=102,561). Risk Profile Management method vs. Conventional single-point estimate of overall observed-to-expected mortality ratio was evaluated on Hospital mortality risk profiles. The Risk Profile Management method enables direct comparison of individual ICUs based on specific mortality risk profiles, providing an advantage over conventional single-point mortality estimates.
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