Experience from ICU audits: the Case Mix Programme

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Experience from ICU auditsthe Case Mix Programme

• Kathy Rowan
• Director

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Case Mix Programme

• National, comparative audit of patient outcome
• 160 recruited/trained units -143 (60.9) adult
  general units in England (50)Wales (50)
  N.Ireland
• Units in 28 24 ) (32.5) university or
  affiliated 108 (67.5) non-university
• Confidential
• Case mix (risk) adjusted
• Consecutive admissions

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Case Mix Programme - history

• 1987- ICS UK APACHE II study
• 1991 Proposal to Government
• 1994 Establishing ICNARC
• 1995 Establishing the Case Mix Programme
• 1996- CMP roll-out
• 1997- CMP development

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Case Mix Programme recruitment

• Visit
• Data collection training (2 days)
• Pilot data collection period (6 weeks)
• Full data collection

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Case Mix Programme dataset

• Alphanumeric identifiers (unit/admission)
• Sociodemographic (age, sex, postcode)
• Organisational (source, date/time in/out etc.)
• First 24 hour physiology forAPACHE II/III, SAPS
  II, MPM0/24
• Outcome (unit/hospital, immediate/ultimate)

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Case Mix Programme data entry/export

• Dataset specification (rules/definitions)
• Raw data
• Software/software developers

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Case Mix Programme data validation

• Local/central
• Completeness
• Illogicalities
• Inconsistencies
• Reliability (optional)

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Case Mix Programme feedback

• Comparative data analysis reports
• Ad hoc specific analyses
• Annual Meeting
• Publications

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Case mix adjusted mortality by method for all
eligible admissions to your unit in this cycle
from 01/07/99 to 29/12/99        
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Case Mix Programme impact

• Survey (1999)

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Uses of reports comparison

• to indicate how we compare to other units
• investigating outcomes for specific groups
• ...feedback to unit staff and user groups on
  issues such as outcomes, occupancy, case mix and
  review of practice
• ...bench-marking - comparison of mortality with
  other units
• analysis of unexpected survivors/non-survivors
  
• outcomes for patients transferred out of base
  hospital due to shortage of beds

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Uses of reports informing change

• to tighten up ICU admission policy
• as evidence for the need for an HDU
• as evidence to set up a Medical Emergency Team
  in hospital
• for development of operational policy
• to evaluate safety and workload
• planning of future paediatric services

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Uses of reports monitoring change

• to monitor actual changes in consultant cover
  and an increase in the number of beds
• to assess the impact of opening up an HDU
• ...looking at the effect of opening an extra
  bed

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Case Mix Programme impact

• Survey (1999)
• Correspondence (mild enquiries to threats!)

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Case Mix Programme feedback

• Comparative data analysis reports
• Ad hoc specific analyses
• Annual Meeting
• Publications

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Case Mix Programme Database

• High quality clinical database
• 75,621 admissions to 102 units(138,545
  admissions to 136 units as of 27/3/01)
• Median size 5 beds (range 2-22)
• Representative

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Is there an ideal scoring system from those
available for adult intensive care or can we
design a better one?
To develop and validate the optimum method for
risk adjustment of hospital mortality for adult
intensive care in the UK. Commenced Sept.
1999. Duration 3 years. (Ph.D.)
An evaluation of the clinical and
cost-effectiveness of Pulmonary Artery Catheters
in patient Management (PAC-Man) in intensive
care. Commenced July 2000. Duration 3 years.
Teamwork and safety attitudes in intensive care.
A National Questionnaire survey of UK
ICUs. Commenced Aug. 2000. Duration 2 years.
How can we establish research priorities for
intensive care?
Which outcome measures are best for intensive
andhigh dependency care?
ICNARCs funded research programme April 2001
Outcome measures for adult critical care a
systematic review. HTA Report published Oct.
2000.Publication submitted Nov. 2000.
Use of consensus development to
establish national research priorities in
critical care. Published BMJ Apr. 2000, ICM
Oct. 2000.
Can large databases such as the Case Mix
Programme Database facilitate research
on clinical interventions?
Optimisation of scoring systems for
paediatric intensive care.
How does a units organisation affect patient
outcome?
The development and assessment of the optimal
risk adjustment methods for outcomes in
paediatric intensive care in the UK. Commenced
July 2000. Duration 3 years.
Evaluation using an high quality clinical
database. Commenced Oct. 1999. Duration 4
years. (Ph.D.)
The organisation of work in intensive
care.Commenced Oct. 1999. Duration 3 years.
(Ph.D.)
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Thanks!