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Contemporary Reviews in Critical Care Medicine |

ICU Director DataICU Director Data: Using Data to Assess Value: Using Data to Assess Value, Inform Local Change, and Relate to the External World

David J. Murphy, MD, PhD; Ogbonna C. Ogbu, MD; Craig M. Coopersmith, MD
Author and Funding Information

From the Emory Critical Care Center (Drs Murphy, Ogbu, and Coopersmith), Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (Drs Murphy and Ogbu), and Department of Surgery (Dr Coopersmith), Emory University School of Medicine, Atlanta, GA.

CORRESPONDENCE TO: David J. Murphy, MD, PhD, Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, 550 Peachtree St, NE, Atlanta, GA 30308; e-mail: david.j.murphy@emory.edu


FUNDING/SUPPORT: This work was supported by funding from the National Institutes of Health [GM095442].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(4):1168-1178. doi:10.1378/chest.14-1567
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Improving value within critical care remains a priority because it represents a significant portion of health-care spending, faces high rates of adverse events, and inconsistently delivers evidence-based practices. ICU directors are increasingly required to understand all aspects of the value provided by their units to inform local improvement efforts and relate effectively to external parties. A clear understanding of the overall process of measuring quality and value as well as the strengths, limitations, and potential application of individual metrics is critical to supporting this charge. In this review, we provide a conceptual framework for understanding value metrics, describe an approach to developing a value measurement program, and summarize common metrics to characterize ICU value. We first summarize how ICU value can be represented as a function of outcomes and costs. We expand this equation and relate it to both the classic structure-process-outcome framework for quality assessment and the Institute of Medicine’s six aims of health care. We then describe how ICU leaders can develop their own value measurement process by identifying target areas, selecting appropriate measures, acquiring the necessary data, analyzing the data, and disseminating the findings. Within this measurement process, we summarize common metrics that can be used to characterize ICU value. As health care, in general, and critical care, in particular, changes and data become more available, it is increasingly important for ICU leaders to understand how to effectively acquire, evaluate, and apply data to improve the value of care provided to patients.

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