Using computerized medical databases to measure and to improve the quality of intensive care.

This article reviews the potential for using computerized databases to measure the quality of care in the intensive care unit. There are 2 types of computerized databases used to assess quality of care: administrative databases used primarily for purposes other than medical care and electronic medical record databases collected specifically for clinical purposes. Quality of care is a difficult property to measure but is generally assessed along 3 domains: structure, process, and outcome. There are several problems with using computerized medical databases to measure and improve quality of care. Many factors known to be important to measuring the severity of illness and process of care in critically ill patients are not captured in routine administrative databases. The criteria for the ethical use of electronic medical record data for research, clinical care, and quality improvement are identical to those that should be applied to using paper medical records. Standardizing a minimal intensive care unit dataset, identifying and measuring optimal processes of care, and understanding the limits of risk adjusted outcomes are all important steps in the process of the optimal use of computerized databases to study and improve the quality of care in the intensive care unit.