The use of clinical outcomes data to evaluate how well intensive care units (ICUs) are performing, especially data provided by severity scoring systems, has received increasing attention as both a method to help consumers choose between available providers and a method to improve delivery of health care. Although the use of outcomes for these purposes offers important insights, and has advantages over other possible approaches, it is not necessarily the most appropriate method to accomplish either purpose. This presentation examines the use of outcomes for the purposes of ICU evaluation and improvement. Theoretical and practical strengths and weaknesses of an outcomes-centered approach to ICU evaluation are discussed. A more comprehensive conceptual framework, which includes the use of performance variables to evaluate and improve ICU performance, is presented.
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