As one attempts to asses the outcomes of critically ill patients, one is confronted by the question of how to measure them, and which ones are important. A range of options exist. For instance, one may measure "hard" outcomes (mortality) - a straightforward metric which can be collected at different time intervals. Alternatively, one may collect "POEM" data (Patient Oriented Endpoint that Matters) which is more interested in quality of life, functional status and other more subjective issues like "satisfaction".
Question 25 from the first paper of 2013 asked the trainees to discuss the advantages and limitations of commonly used endpoints as a measure of quality of critical care. A question like this probably lends itself better to a tabulated answer, and so I went ahead and tabulated it (the table is made available below, and is identical to the table in the discussion section of Question 25).
Possible reading material for this topic may include the following resources:
- The LITFL article on this topic is probably enough for the time-poor candidate
- A good discussion of "at what point do we measure mortality" can be found at the AIHW statement on Measuring and reporting mortality in hospital patients (page 6, ch. 2.4.2).
- As a good guideline for other ICU outcome measures which should be used to assess the outcomes of Phase II trials, ANZICS has published this statement in 2012 (the 2013 update is for some reason not available for free).
- A good discussion of ICU outcome measures and some of their limitations can also be found in the 1999 workshop publication of the American Thoracic Society.
As an interesting aside, a recent (2016) report by Turbull et al remarked that "peer-reviewed publications reporting patient outcomes after hospital discharge for ICU survivors have grown from 3 in the 1970s to more than 300 since 2000", and complained that "the ability to compare results across studies remains impaired by the 250 different instruments used" which means that virtually every second study used a different instrument (in total 425 eligible articles were reviewed).
|1-year functional outcome||