The aim of this proposal is to adress the methodological issues surronding case mix adjustement methods in intensive care, in order to propose an European standardization of patient data collection of ICUs outcome assessment, in order to improve the quality of Health Care and establish a quality culture in European Health Care institutions.
Conclusive comparisons of Outcome of Intensive Care Units (ICUs) would require controlled trials where patients were randomly assigned to receive intensive care or not. Since this design is deemed unethical, observational methods are employed. The performance of the units by comparing the ratio of observed / predicted death rate by a probability model is the method of choice. Nevertheless, that the variation in this ratio was due to management differences and not to variations of case - mix remains unproved. Amongst the European countries the variables collected for case - mix (comorbidities, severity, diagnoses, lead time bias) are different, giving the impression of chaos. The methods of this study consist of pooling the key people and the key data, since there is a considerable experience in Europe. The plan of action is as follows:
- Implementation of a centralized Data Bank of all the information on case mix methods (instruments and guidelines for applications) as developed or applied for use in adult intensive care. Overview and systematic analysis of case - mix and outcome data collected across Europe. Qualitative comparison of the instruments and guidelines for application used for collection of case - mix and outcome across Europe.
The results will be the edition of guidelines for the standardized collection of case mix and outcome data across Europe and the production of a prioritized research agenda addressing future research requirements in the area of case mix adjustement in Intensive Care in Europe. The participants will organize meetings in their own country to teach data collectors for harmonization of data collection.