Provision of outcomes data

There is a growing need to provide patients and clinicians with information about outcomes from care delivered in ICUs, since the consumer of tomorrow mill be making informed decisions based on healthcare report cards, which include ICU care. To date, mortality rate has been the main outcome examine d in critical care medicine. Because the ICU uniquely highlights the confli cting issues of high cost and lifesaving technology, outcomes cannot be bas ed on mortality rates alone, but also need to consider issues such as quali ty of life, functional status, health status, change in physiologic paramet ers, cost, length of stay, infection rates, and quality of death. This arti cle describes a new methodology, Clinical Practice Improvement, which exami nes outcomes but also connects them to detailed patient characteristics and treatment interventions to determine which treatments are associated with better outcomes in the ICU, controlling for patient differences. We describ e how this approach goes beyond the usual outcomes research and the usual g uideline development approaches, and we contrast this approach with randomi zed, controlled trials. By the year 2010, after computerized information sy stems are widely implemented in hospitals, Clinical Practice Improvement me thodology can download information to determine patient-specific protocols that improve clinical outcomes and reduce the cost of care.