title: Quality assessment in intensive care units: proposal for a scoring system in terms of structure and process.
abstract: OBJECTIVE
  We present a score for assessing the quality of ICU care in terms of structure and process, based on bibliographic review, expert consultations, field test, analysis, and final consensus, and analyze its initial application in the field.
  
  
  METHODS
  This feasibility and observational study was conducted within the framework of a French regional clinical research project (NosoQual); 40 ICUs were visited and assessed between November 2002 and March 2003 according to standardized procedures.
  
  
  RESULTS
  The grid consisted of 95 variables. The overall score derived from seven independent quality dimensions: human resources, architecture, safety and environment, management of documentation, patient care management, risk management of infections and evaluation, and surveillance. The average level of achievement of the scores varied from 48% to 63% of theoretical maxima. Variability in the individual dimensional subscores was greater than that of the overall score (CV=15).
  
  
  CONCLUSIONS
  Evaluation this scoring system encounters the limitation of the absence of a "gold standard." However, this is counterbalanced by the rigorous design methodology, the characteristic strengths of the quality dimensions. The survey also highlights also feasibility and the potential interest for specific tools for the assessment of ICUs.
authors.affiliation: Université de Lyon, Laboratoire d'Epidémiologie et Santé Publique, 8 avenue Rockefeller, 69373, Lyon Cedex 08, France. josette.najjar@univ-lyon1.fr
authors.forename: Josette
authors.initials: J
authors.lastname: Najjar-Pellet
authors.forename: Olivier
authors.initials: O
authors.lastname: Jonquet
authors.forename: Patrick
authors.initials: P
authors.lastname: Jambou
authors.forename: Jacques
authors.initials: J
authors.lastname: Fabry
mesh_terms: D003697:Delphi Technique; D005240:Feasibility Studies; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000145:classification / Q000592:standards*; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care