Quality assessment of adult intensive care services: application of a tool adjusted to the reality of low-income countries

ABSTRACT Objective: To assess the quality of adult intensive care units. Methods: This population-based, cross-sectional, observational, analytical study evaluated management type in Maranhão, Brazil. An assessment instrument was applied that assigned scores to each service (maximum 124 points). The units were categorized as insufficient (< 50% of the maximum score), typical (≥ 50% and <80% of the maximum score), or sufficient (≥ 80% of the maximum score). Results: Of the 26 intensive care units in Maranhão, 23 were evaluated; 15 (65.2%) were located in the state capital, and 14 (60.9%) were public. The mean final score was 67.2 (54.2% of the maximum). The worst performance was observed with regard to processes (50.9%) in the units located outside the capital (p = 0.037) and for hospitals with 68 beds or fewer (p = 0.027). The result of the assessment categorized services as a function of the overall total points earned. Specifically, 8 (34.8%) services were assessed as insufficient, 13 (56.5%) were assessed as typical, and 2 (8.7%) were assessed as sufficient. Conclusion: The majority of the intensive care units in this study were assessed as typical. These services must be better qualified. The priorities are the processes of the units located outside the capital and in small hospitals.

摘要
研究目的：评估成人重症监护病房（Intensive Care Unit, ICU）的质量。
研究方法：本项基于人群的横断面观察性分析研究，针对巴西马拉尼昂州的重症监护病房管理模式进行评估。研究采用标准化评分工具对各病房进行评分，满分为124分，并依据总得分将所有参评病房划分为三类：不合格（得分低于满分的50%）、达标（得分≥50%且<80%的满分占比）、优秀（得分≥80%的满分占比）。
研究结果：马拉尼昂州共有26家重症监护病房，最终完成评估23家；其中15家（占比65.2%）位于州首府，14家（占比60.9%）为公立医疗机构。研究对象的平均最终得分为67.2分，相当于满分的54.2%。流程管理维度的得分率仅为50.9%，且该维度表现最差的情况出现在首府以外的病房（p=0.037）以及床位≤68张的医院（p=0.027）。依据总得分对病房进行分类后，8家（占比34.8%）评定为不合格，13家（占比56.5%）为达标等级，2家（占比8.7%）为优秀等级。
研究结论：本研究中绝大多数重症监护病房评定为达标等级，提示此类病房仍需进一步优化提质。其中，首府以外区域的病房以及小型医院的流程管理维度为质量改进的优先方向。