Articles: outcome-assessment-health-care.
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There are now two validated time points for predicting hospital mortality of ICU patients--at admission and at 24 hours. The best purposes include evaluation of high clinical performance ICUs and for patients being enrolled in clinical trials. For the latter purpose, the model must be calibrated in the individual hospital to ensure that the model is applicable. ⋯ The mathematical link between physiology score and estimation of hospital mortality is established only for the time point of 24 hours after ICU admission. Calibration and discrimination of the admission and 24-hour models also must be performed within each hospital in which individual probabilities are presented to families. It may be possible to customize a probability model such as MPM to achieve a high level of calibration at the individual hospital level.
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Meeting the challenges of allocating critical care resources in the fairest way possible depends upon the development of a standardized strategy for apportioning ICU services in times of limited supply. Two main approaches are emerging to handle these challenges. ⋯ The second approach involves improving the efficiencies of the care giving system itself. Either approach requires the establishment of a standard of care that reduces the potential for personal biases into the decision making process.
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Clinics in chest medicine · Sep 1993
ReviewOutcome assessment in elderly patients with critical illness and respiratory failure.
Although elderly patients tend to have diminished physiologic reserve, the independent impact of age on outcome from critical illness is controversial. Physiologic status is perhaps a more important measure of a patient's underlying health and anticipated response to critical illness. Age, therefore, should not be used as a sole determinant for intensive care department admission.