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Editorials |

Benchmarking in Critical Care : The Road Ahead

Laurent G. Glance, MD; James E. Szalados, MD, MBA, MHA, FCCP
Author and Funding Information

Affiliations: Rochester, NY 
 ,  Dr. Glance is Associate Professor of Anesthesiology, and Dr. Szalados is Associate Professor of Anesthesiology and Vice-Chairman, Department of Anesthesiology, University of Rochester School of Medicine and Dentistry.

Correspondence to: James E. Szalados, MD, FCCP, Department of Anesthesiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642



Chest. 2002;121(2):326-328. doi:10.1378/chest.121.2.326
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In this issue of CHEST (see page 539), Sirio et al compare critical care outcomes in the United States and Japan after accounting for differences in severity of disease and case mix using APACHE (acute physiology and chronic health evaluation) III. One of the objectives of international comparisons of critical care delivery systems is to determine if differences in resource use translate into differences in health-care outcomes. This study found that the observed and expected mortality rates in the Japanese cohort were identical. This finding is notable given the fact that hospital length of stays in Japan are significantly longer than they are in the United States due to differences in discharge policies. The authors point out that longer hospital length of stays are usually associated with higher hospital mortality rates, inferring that the aggregate outcomes in the Japanese data set may be better than expected. However, this study does not include information on the processes of care that may have led to improved outcomes relative to the American cohort. This study reminds us that one of the primary goals of outcomes information is to identify high-performance hospitals or health-care delivery systems so that we can uncover the “best practices” responsible for their superior outcomes and then implement them in other settings.1 Although there is little evidence to suggest that we are making significant progress toward accomplishing this goal, the work of O’Connor et al2 in the Northern New England Cardiovascular Disease Study Group demonstrates the potential for improving mortality rates through quality-improvement initiatives grounded in outcomes information. Furthermore, following the publication of the Institute of Medicine report on patient safety, there now exists a national mandate to search for processes of care that will minimize medical errors and improve patient outcomes.3

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