QRB. Quality review bulletin
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Critical care units have proliferated over the past three decades and the cost of care in these units has increased dramatically during that period. These units have flourished despite a surprising lack of adequate data to support their overall efficacy, and indeed a number of studies suggest that many patients admitted to these units are either too ill or too healthy to benefit. Dr Luce reviews recent changes in the organization and delivery of critical care and argues that the utilization and quality of critical care units can be improved through a combination of strategies. ⋯ In addition, although nominally eschewing the use of "formal" rationing policies, he advocates the development of admission and discharge policies to guide physicians during periods of low bed availability. Finally, he advocates greater leadership roles for professional critical care unit directors. This final suggestion has great merit but, as Dr Luce recognizes, a heightened role for critical care unit directors raises ethical and legal issues about the autonomy of both patients and physicians that need to be explored thoroughly.
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Review
Applying insurance claims data to assess quality of care: a compilation of potential indicators.
Insurance claims records, which document many aspects of the process and outcome of medical care, are a practical and unobtrusive source of data for monitoring the quality of care provided to enrollees--a purpose for which they are rarely used. Data for these potential indicators could be drawn from claims or other administrative data systems. The authors established categories of care that could be used to develop claims-based indicators and compiled an annotated list of broad indicators for assessing the quality of care. The compilation of indicators is preceded by a discussion of some of the issues and challenges facing those who use and interpret claims-based indicators of quality.
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Anesthesiology is considered a leading specialty with respect to medical risk management and patient safety. The American Society of Anesthesiologists (ASA) developed its first practice guidelines in 1968 and published its first set of stricter practice standards in 1986. The standards are detailed specifications for the minute-to-minute conduct of anesthesia practice. An impetus for ASA standards development has been the belief that physicians should develop their own standards rather than have them imposed by nonphysician third parties.