National ICU Registries as Enablers of Clinical Research and Quality Improvement
Jorge I F Salluh 1 2, Amanda Quintairos 1 3, Dave A Dongelmans 4 5, Diptesh Aryal 6, Sean Bagshaw 7 8, Abigail Beane 9 10, Gaston Burghi 11, Maria Del Pilar Arias López 12 13, Stefano Finazzi 14 15, Bertrand Guidet 16, Satoru Hashimoto 17, Nao Ichihara 18, Edward Litton 19 20, Nazir I Lone 21 22, Vrindha Pari 23, Cornelius Sendagire 1 24, Bharath Kumar Tirupakuzhi Vijayaraghavan 25 26, Rashan Haniffa 9 27 28, Luigi Pisani 9, David Pilcher 29; Linking of Global Intensive Care (LOGIC) and Japanese Intensive care PAtient Database (JIPAD) Working Group
Objectives: Clinical quality registries (CQRs) have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. This narrative review describes the challenges, proposed solutions, and evidence generated by National ICU registries as facilitators for research and quality improvement.
Data sources: English language articles were identified in PubMed using phrases related to ICU registries, CQRs, outcomes, and case-mix.
Study selection: Original research, review articles, letters, and commentaries, were considered.
Data extraction: Data from relevant literature were identified, reviewed, and integrated into a concise narrative review.
Data synthesis: CQRs have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. The initial experience in European countries and in Oceania ensured that through locally generated data, ICUs could assess their performances by using risk-adjusted measures and compare their results through fair and validated benchmarking metrics with other ICUs contributing to the CQR. The accomplishment of these initiatives, coupled with the increasing adoption of information technology, resulted in a broad geographic expansion of CQRs as well as their use in quality improvement studies, clinical trials as well as international comparisons, and benchmarking for ICUs.
Conclusions: ICU registries have provided increased knowledge of case-mix and outcomes of ICU patients based on real-world data and contributed to improve care delivery through quality improvement initiatives and trials. Recent increases in adoption of new technologies (i.e., cloud-based structures, artificial intelligence, machine learning) will ensure a broader and better use of data for epidemiology, healthcare policies, quality improvement, and clinical trials.
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Conflict Of Interest Statement
Dr. Beane received support for article research from Wellcome Trust/Charity Open Access Fund (COAF). Drs. Pilcher and Litton are members of the Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation management committee. Drs Salluh is co-founder and shareholder of Epimed Solutions, a healthcare cloud-based analytics company. He is also supported, in part, by individual research grants from the National Council for Scientific and Technological Development and Research Support Foundation of the State of Rio de Janeiro. Dr. Dongelmans is unpaid chair of National Intensive Care Evaluation Foundation. Dr. Ichihara’s primary affiliation is the Department of Healthcare Quality Assessment, which is a social collaboration department at the University of Tokyo supported by National Clinical Database, Johnson & Johnson K.K., and Nipro Corporation. Dr. Vijayaraghavan is the National Coordinator for the Indian Registry of IntenSive Care and is supported for 0.5 full-time equivalent hours by funding from the Wellcome Trust, U.K. Dr. Bagshaw received funding from Baxter and BioPorto. Dr. Hashimoto’s institution received funding from the Japanese Ministry of Health, Labour and Welfare for the Japanese Intensive care PAtient Database (JIPAD), the Japanese Society of Intensive Care Medicine, and JMS. Dr. Haniffa’s institution received funding from Wellcome Trust/COAF and UK Research and Innovation (UKRI); he disclosed that he is an honorary director of National Intensive Care Surveillance MORU. Dr. Pisani received funding from Wellcome Trust and The African Critical Care registry network funded by this UKRI MRC (grant MR/V030884/1). The remaining authors have disclosed that they do not have any potential conflicts of interest.