The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil

ABSTRACT Objective: To describe the Epimed Monitor Database®, a Brazilian intensive care unit quality improvement database. Methods: We described the Epimed Monitor® Database, including its structure and core data. We presented aggregated informative data from intensive care unit admissions from 2010 to 2016 using descriptive statistics. We also described the expansion and growth of the database along with the geographical distribution of participating units in Brazil. Results: The core data from the database includes demographic, administrative and physiological parameters, as well as specific report forms used to gather detailed data regarding the use of intensive care unit resources, infectious episodes, adverse events and checklists for adherence to best clinical practices. As of the end of 2016, 598 adult intensive care units in 318 hospitals totaling 8,160 intensive care unit beds were participating in the database. Most units were located at private hospitals in the southeastern region of the country. The number of yearly admissions rose during this period and included a predominance of medical admissions. The proportion of admissions due to cardiovascular disease declined, while admissions due to sepsis or infections became more common. Illness severity (Simplified Acute Physiology Score - SAPS 3 - 62 points), patient age (mean = 62 years) and hospital mortality (approximately 17%) remained reasonably stable during this time period. Conclusion: A large private database of critically ill patients is feasible and may provide relevant nationwide epidemiological data for quality improvement and benchmarking purposes among the participating intensive care units. This database is useful not only for administrative reasons but also for the improvement of daily care by facilitating the adoption of best practices and use for clinical research.

摘要
研究目的：旨在介绍巴西重症监护病房质量改进类数据库——Epimed监护数据库（Epimed Monitor Database®）。
研究方法：本研究对Epimed监护数据库的结构与核心数据进行了详细阐述，采用描述性统计方法展示了2010年至2016年期间重症监护病房收治患者的汇总信息；同时介绍了该数据库的扩张与发展历程，以及巴西境内参与单位的地理分布特征。
研究结果：该数据库的核心数据涵盖人口统计学、行政管理及生理学参数，同时包含用于收集重症监护病房资源使用、感染事件、不良事件相关详细数据的专用报告表单，以及用于评估临床最佳实践依从性的核查清单。截至2016年底，巴西318家医院的598家成人重症监护病房参与该数据库，合计开放重症监护床位8160张。参与单位大多位于巴西东南部地区的私立医院。在此研究周期内，年度收治患者总量呈上升趋势，且以内科收治患者占比最高。因心血管疾病收治的患者占比逐步下降，而因脓毒症或感染收治的患者占比逐渐升高。此期间，患者疾病严重程度[简化急性生理学评分3（Simplified Acute Physiology Score 3, SAPS 3）：平均62分]、患者平均年龄（62岁）及医院病死率（约17%）均保持相对稳定。
研究结论：大型私立重症患者数据库的构建具备可行性，可为参与该数据库的重症监护病房提供具有全国代表性的流行病学数据，用于质量改进与基准对标工作。该数据库不仅可满足行政管理需求，还可通过推动临床最佳实践的落地应用，助力提升日常诊疗质量并支持临床研究开展，具有重要的应用价值。