Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-15T16:18:32.173Z Has data issue: false hasContentIssue false
  • English
  • Français

Problems in Assessing the Technology of Critical Care Medicine

Published online by Cambridge University Press:  14 October 2009

William J. Sibbald  and
Kevin J. Inman
William J. Sibbald
Affiliation:
Victoria Hospital, London, Ontario
Kevin J. Inman
Affiliation:
Victoria Hospital, London, Ontario
Get access Rights & Permissions [Opens in a new window]

Abstract

Technology assessment is becoming increasingly important in the area of critical care due both to the explosion of technology associated with this discipline and to the realization that future demand for these health care resources will undoubtedly exceed the ability to pay. Technology assessment remains both confusing and controversial to many physicians. This review tries to address some of the confusion by reviewing the basic strategies involved in this process. From there, problems and prospects for the evaluation of critical care as a program are presented, followed by the assessment of components within the area of critical care. Finally, recommendations are made on how technology assessment could proceed in the future to best achieve the efficient provision of this service.

Type
Special Section: Intensive Care: Where Are We?
Information
International Journal of Technology Assessment in Health Care , Volume 8 , Issue 3 , Summer 1992 , pp. 419 - 443
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Armitage, P.Sequential medical trials. New York: John Wiley and Sons, 1975.Google Scholar
2.Baba, A. A., McKillop, J. H., Cuthbert, G. F., et al. Indium 111 leucocyte scintigraphy in abdominal sepsis: Do the results affect management? European Journal of Nuclear Medicine, 1990, 16, 307–09.CrossRefGoogle ScholarPubMed
3.Bates, D. V.“Workshop on Intensive Care Units,” comments of the National Academy of Sciences, National Research Council, Committee on Anesthesia. Anesthesiology, 1964, 25, 192.Google Scholar
4.Battista, R. N.Innovation and diffusion of health-related technologies: A conceptual framework. International Journal of Technology Assessment in Health Care, 1989, 5, 227–43.CrossRefGoogle ScholarPubMed
5.Berenson, R. A. Intensive care units (ICUs): Clinical outcomes, costs, and decisionmaking. Health Technology Case Study 28, Prepared for the Office of Technology Assessment, 1984.Google Scholar
6.Bone, R. C., Fisher, C. J. JrClemmer, T. P., et al. Sepsis syndrome: A valid clinical entity. Critical Care Medicine, 1989, 17, 389–93.CrossRefGoogle ScholarPubMed
7.Brown, J. J., & Sullivan, G.Effect on ICU mortality of a full-time critical care specialist. Chest, 1989, 96, 127–29.CrossRefGoogle ScholarPubMed
8.Byrick, R. J., Mindor, F. F., McKee, L., & Mudge, B.Cost-effectiveness of intensive care for respiratory failure patients. Critical Care Medicine, 1980, 6, 332–37.CrossRefGoogle Scholar
9.Califano, J. A.The health care chaos. New York Times Magazine, 1988, 44, 44–48.Google Scholar
10.Casali, R., et al. Acute renalinsufficiency complicating major cardiovascular surgery. American Journal of Surgery, 1975, 181, 370.Google Scholar
11.Cecil, W. T., Petterson, M. T., Lamoonpun, S., & Rudolph, C. D.Clinical evaluation of the Biox IIA ear oximeter in the critical care environment. Respiratory Care, 1985, 30, 179–83.Google Scholar
12.Chassin, M. R.Costs and outcomes of medical intensive care. Medical Care, 1982, 20, 165.CrossRefGoogle ScholarPubMed
13.Choe, H., Tashiro, C., Fukumitsu, K., Yagi, M., & Yoshiya, I.Comparison of recorded values from six pulse oximeters. Critical Care Medicine, 1989, 17, 678–81.CrossRefGoogle ScholarPubMed
14.Cullen, D. J., Civetta, J. M., Burton, B. A., & Ferrara, L. C.Therapeutic Intervention Scoring System: A method for quantitative comparison of patient care. Critical Care Medicine, 1974, 2, 57–60.CrossRefGoogle ScholarPubMed
15.Cullen, D. J., Ferrara, L. C., & Briggs, B. A.Survival, hospitalization charges and follow-up results in critically ill patients. New England Journal of Medicine, 1976, 294, 892–95.CrossRefGoogle ScholarPubMed
16.Deber, R. B., Thompson, G. G., Leatt, P.Technology acquisition in Canada. International Journal of Technology Assessment in Health Care, 1988, 4, 185–206.CrossRefGoogle ScholarPubMed
17.Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre. How to read clinical journals: II. To learn about a diagnostic test. Canadian Medical Association Journal, 1981, 124, 703–10.Google Scholar
18.DerSimonian, R., Charette, L. J., McPeek, B., et al. Reporting on methods in clinical trials. New England Journal of Medicine, 1982, 306, 1332–37.CrossRefGoogle ScholarPubMed
19.Detsky, A. S., & Naglie, G.A clinician's guide to cost-effectiveness analysis. Annals of Internal Medicine, 1990, 113, 147–54.CrossRefGoogle ScholarPubMed
20.Donabedian, A.The assessment of technology and quality: A comparative study of certainties and ambiguities. International Journal of Technology Assessment in Health Care, 1988, 4, 487–96.CrossRefGoogle ScholarPubMed
21.Doubilet, P., Weinstein, M. C., & McNeil, B. J.Use and misuse of the term “cost effective” in medicine. New England Journal of Medicine, 1986, 314, 253–56.CrossRefGoogle ScholarPubMed
22.Dragsted, L., Jorgensen, J., Jensen, N., et al. Interhospital comparisons of patient outcome from intensive care: Importance of lead time bias. Critical Care Medicine, 1989, 17, 418–22.CrossRefGoogle ScholarPubMed
23.Drake, W. E. JrAcute stroke management and patient outcome: The value of neurovas-cular care units (NCU). Stroke, 1973, 4, 933.CrossRefGoogle Scholar
24.Escarce, J. J., Kelley, M. A.Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score. Journal of the American Medical Association, 1990, 264, 2389–94.CrossRefGoogle Scholar
25.Fedullo, A. J., & Swinburne, A. J.Relationship of patient age to cost and survival in a medical ICU. Critical Care Medicine, 1983, 11, 155–59.CrossRefGoogle Scholar
26.Feller, I., Tholen, D., & Cornell, R. G.Improvements in burn care, 1965 to 1979. Journal of the American Medical Association, 1980, 244, 2074–78.CrossRefGoogle ScholarPubMed
27.Flood, A. B., Scott, W. R., Ewy, W.Does practice make perfect? Part I. The relation between hospital volume and outcomes for selected diagnostic categories. Medical Care, 1984, 22, 98–114.CrossRefGoogle ScholarPubMed
28.Fuchs, V. R., & Garber, A. M.The new technology assessment. New England Journal of Medicine, 1990, 323, 673–77.CrossRefGoogle ScholarPubMed
29.Griner, P. F.Treatment of acute pulmonary edema: Conventional or intensive care? Annals of Internal Medicine, 1972, 77, 501–06.CrossRefGoogle ScholarPubMed
30.Guyatt, G. H., Keller, J. L., Jaeschke, R. et al. The n-of-1 randomized controlled trial: Clinical usefulness. Annals of Internal Medicine, 1990, 112, 293–99.CrossRefGoogle ScholarPubMed
31.Guyatt, G. H., Sackett, D., Adachi, J., et al. A clinician's guide for conducting randomized trials in individual patients. Canadian Medical Association Journal, 1988, 139, 497–503.Google ScholarPubMed
32.Harvey, A. M.Neurosurgical genius-Walter Edward Dandy. Johns Hopkins Medical Journal, 1974, 135, 358–68.Google ScholarPubMed
33.Holly, N.A call for randomized controlled cost-effectiveness analysis of percutaneous trans-luminal coronary angioplasty. International Journal of Technology Assessment in Health Care, 1988, 4, 497–510.CrossRefGoogle Scholar
34.Hook, E. W., Horton, C. A., & Schaberg, D. R.Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. Journal of American Medical Association, 1983, 249, 1055–57.CrossRefGoogle ScholarPubMed
35.Hopefl, A. W., Taafffe, C. L., Herrmann, V. M.Failure of APACHE II alone as a predictor of mortality in patients receiving total parenteral nutrition. Critical Care Medicine, 1989, 17, 414–17.CrossRefGoogle ScholarPubMed
36.Jennett, B.Inappropriate use of intensive care. British Medical Journal, 1984, 289, 1709–11.CrossRefGoogle ScholarPubMed
37.Jennett, B.Resource allocation for the severely brain damaged. Archives Neurology, 1976, 33, 595–97.CrossRefGoogle ScholarPubMed
38.Jennett, B.Assessment of a technological package using a predictive tool. International Journal of Technology Assessment in Health Care, 1987, 3, 335–38.CrossRefGoogle ScholarPubMed
39.Jennett, B., & Teasdale, G.Assessment of outcome after severe brain damage. Lancet, 1975, 1, 480–84.CrossRefGoogle ScholarPubMed
40.Keene, A. R., & Cullen, D. J.Therapeutic Intervention Scoring System: Update 1983. Critical Care Medicine, 1983, 11, 1–3.CrossRefGoogle ScholarPubMed
41.Kelen, G. D., Brown, C. G., Moser, M., et al. Reporting methodology protocols in three acute care journals. Annals of Emergency Medicine, 1985, 14, 880–84.CrossRefGoogle ScholarPubMed
42.Knaus, W. A., Draper, E. A., Wagner, D. P., et al. Evaluating outcome from intensive care: A preliminary multihospital comparison. Critical Care Medicine, 1982, 491–96.CrossRefGoogle ScholarPubMed
43.Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E.An evaluation of outcome from intensive care in major medical centers. Annals of Internal Medicine, 1986, 104, 410–18.CrossRefGoogle ScholarPubMed
44.Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E.APACHE II: A severity of disease classification system. Critical Care Medicine, 1985, 13, 818–29.CrossRefGoogle ScholarPubMed
45.Knaus, W. A., LeGall, J. R., et al. A comparison of intensive care in the U.S.A. and France. Lancet, 1982, 18, 642–46.CrossRefGoogle Scholar
46.Knaus, W. A., Zimmerman, J. E., Wagner, D. P., Draper, E. A., et al. APACHE-Acute physiology and chronic health evaluation: A physiologically based classification system. Critical Care Medicine, 1981, 9, 591–97.CrossRefGoogle ScholarPubMed
47.Lacroix, J., Infante-Rivard, C., Jenicek, M., & Gauthier, M.Prophylaxis of upper gastrointestinal bleeding in intensive care units: A meta-analysis. Critical Care Medicine, 1989, 17, 862–69.CrossRefGoogle ScholarPubMed
48.Lasch, K., Maltz, A., Mosteller, F., & Tosteson, T.A protocol approach to assessing medical technologies. International Journal of Technology Assessment in Health Care, 1987, 3, 103–22.CrossRefGoogle ScholarPubMed
49.LeGall, J. R., Brun-Buisson, C., Tfunet, P., et al. Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Critical Care Medicine, 1982, 10, 575–77.Google Scholar
50.Luft, H.The relation between surgical volume and mortality: An exploration of causal factors and alternative models. Medical Care, 1980, 18, 940–46.CrossRefGoogle ScholarPubMed
51.Luft, H., Bunker, J., & Enthoven, A.Should operations be regionalized? The empirical relation between surgical volume and mortality. New England Journal of Medicine, 1979, 301, 1364–69.CrossRefGoogle ScholarPubMed
52.Morris, R. W., Nairn, M., & Torda, T. A.A comparison of fifteen pulse oximeters. Part I: A clinical comparison; Part II: A test of performance under conditions of poor perfusion. Anaesthesia Intensive Care, 1989, 17, 62–82.CrossRefGoogle Scholar
53.Moser, M. M.Randomized clinical trials: Alternatives to conventional randomization. American Journal of Emergency Medicine, 1986, 4, 276–85.CrossRefGoogle ScholarPubMed
54.Murata, G. H., & Ellrodt, A. G.Medical intensive care in a community teaching hospital. Western Journal of Medicine, 1982, 136, 462–70.Google Scholar
55.Niehoff, J., DelGuercio, C., LaMorte, W., et al. Efficacy of pulse oximetry and capnom-etry in postoperative ventilatory weaning. Critical Care Medicine, 1988, 16, 701–05.CrossRefGoogle ScholarPubMed
56.Nightingale, F.Notes on Hospitals. 3rd ed.London: Longman, Green, Longman, Roberts and Green, 1863, 89.Google Scholar
57.NIH Consensus Development Conference Statement on Critical Care Medicine. In J. E. Parillo & S. M. Ayres (eds). Baltimore, MD: Williams and Wilkins, 1984, 277–89.Google Scholar
58.Norris, R. M., Brandt, P. W. T., Caughey, D. E., et al. A new coronary prognostic index. Lancet, 1969, 1, 274–81.CrossRefGoogle ScholarPubMed
59.Parno, J. R., Teres, D., Lemeshow, S., et al. Hospital charges and long-term survival of ICU versus non-ICU patients. Critical Care Medicine, 1982, 10, 569–74.CrossRefGoogle ScholarPubMed
60.Pessi, T. T.Experiences gained in intensive care of surgical patients: A prospective clinical study of 1, 001 consecutively treated patients in a surgical intensive care unit. Annals Chiropractic Gynecology, 1973, 62 (Suppl.), 185, 3.Google Scholar
61.Petty, T. L., Lakshminarayan, S., Sahn, S. A., et al., Intensive respiratory care unit: Review of ten years experience. Journal of the American Medical Association, 1975, 233, 34–37.CrossRefGoogle ScholarPubMed
62.Piper, K. W., & Griner, P. F.Suicide attempts with drug overdose: Outcomes of intensive vs. conventional floor care. Archives Internal Medicine, 1974, 134, 703–06.CrossRefGoogle ScholarPubMed
63.Pitner, S. E., & Mance, C. J.An evaluation of stroke intensive care: Results in a municipal hospital. Stroke 1973, 4, 737–41.CrossRefGoogle Scholar
64.Pocock, S. J.The combination of randomized and historical controls in clinical trials. Journal of Chronic Diseases, 1976, 29, 175–88.CrossRefGoogle ScholarPubMed
65.Ranoshoff, D. F., & Feinstein, A. R.Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. New England Journal of Medicine, 1978, 299, 926–30.CrossRefGoogle Scholar
66.Rogers, R. M., Weiler, C., & Ruppenthal, B.Impact of the respiratory intensive care unit in survival of patients with acute respiratory failure. Chest, 1972, 62, 94–97.CrossRefGoogle ScholarPubMed
67.Ron, A., Aronne, L. J., Kalb, P. E., et al. The therapeutic efficacy of critical care units: Identifying subgroups of patients who benefit. Archives of Internal Medicine, 1989, 149, 338–41.CrossRefGoogle ScholarPubMed
68.Rothstein, P., & Johnson, P.Pediatric intensive care: Factors that influence outcome. Critical Care Medicine, 1982, 10, 34–37.CrossRefGoogle ScholarPubMed
69.Sacks, H., Chalmers, T. C., & Smith, H.Randomized versus historical controls for clinical trials. American Journal of Medicine, 1982, 72, 233–40.CrossRefGoogle ScholarPubMed
70.Schwartz, S., & Cullen, D. J.How many intensive care beds does your hospital need? Critical Care Medicine, 1981, 9, 625–29.CrossRefGoogle ScholarPubMed
71.Sheps, S. A., & Schechter, M. T.The assessment of diagnostic tests: A survey of current medical research. Journal of the American Medical Association, 1984, 252, 2418–22.CrossRefGoogle ScholarPubMed
72.Severinghaus, J. W., Naifeh, K. H., & Koh, S. O.Errors in 14 pulse oximeters during profound hypoxia. Journal of Clinical Monitoring, 1989, 5, 72–81.CrossRefGoogle ScholarPubMed
73.Sibbald, W. J., Escaf, M., & Calvin, J. E.How can new technology be introduced, evaluated, and financed in critical care? Clinical Chemistry, 1990, 36, 1604–11.CrossRefGoogle ScholarPubMed
74.Sibbald, W. J., Marshall, J., Christou, N., et al. “Sepsis”-Clarity of existing terminology … Or more confusion? (Editorial) Critical Care Medicine, 1991, 19, 996.CrossRefGoogle ScholarPubMed
75.Skidmore, F. D.A review of 460 patients admitted to the intensive therapy unit of a general hospital between 1965 and 1969. British Journal of Surgery, 1973, 60, 1–16.CrossRefGoogle Scholar
76.Spagnolo, S. V., Hershberg, P. I., & Zimmerman, H. J.Medical intensive care unit: Mortality rate experience in a large teaching hospital. New York State Journal of Medicine, 1973, 73, 754–57.Google Scholar
77.Stoutenbeek, C. P., Van Saene, H. K. F., Miranda, D. R., et al. The effect of selective decontamination of the digestive tract on colonization and infection in multiple trauma patients. Intensive Care Medicine, 1984, 10, 185–92.CrossRefGoogle ScholarPubMed
78.Stoutenbeek, C. P., & Van Saene, H. K. F.Infection prevention in intensive care by selective decontamination of the digestive tract. Journal of Critical Care, 1990, 5, 137–56.CrossRefGoogle Scholar
79.Sydow, M., Burchardi, H., Crozier, T. A., et al. Prospective study of infection and mortality rates in critically ill patients during SDD regimen (abstract). In Van Saene, H. K. F., Stoutenbeek, C. P., Lawin, P., et al. (eds.). Infection control by selective decontamination. Berlin, FRG: Springer Verlag, 1989, 118.CrossRefGoogle Scholar
80.Thibault, G. E., Mulley, A. G., Barnett, C. O., et al. Medical intensive care: Indications, interventions, and outcomes. New England Journal of Medicine, 1980, 302, 938–42.CrossRefGoogle ScholarPubMed
81.Tomlin, P. J.Intensive care-Medical audit. Anaesthesia, 1978, 33, 710–15.CrossRefGoogle Scholar
82.Turnbull, A. D., Carlon, G., Baron, R., et al. The inverse relationship between cost and survival in the critically ill cancer patients. Critical Care Medicine, 1979, 7, 20–23.CrossRefGoogle Scholar
83.Vanholder, R., & Colardyn, F.Prognosis of intensive care patients: Correlation of diagnosis and complications to patient outcome. Acta Clinica Belgica, 1980, 35, 279–86.CrossRefGoogle ScholarPubMed
84.Ziegler, E. J., Fisher, C. J. JrSprung, C. L., et al. Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin: A randomized, double blind, placebo controlled trial. New England Journal of Medicine, 1991, 324, 429–36.CrossRefGoogle ScholarPubMed
85.Zimmerman, J. E. (ed.). APACHE III study design: Analytic plan for evaluation of severity and outcome. Critical Care Medicine, 1989, 17(S), S169–S221.Google Scholar
86.Zimmerman, J. E., Knaus, W. A., Judson, J. A., et al. Patient selection for intensive care: A comparison of New Zealand and United States hospitals. Critical Care Medicine, 1988, 16, 318–26.CrossRefGoogle ScholarPubMed