PROSPERO International prospective register of systematic reviews
Patient and family centered performance measures focused on actionable processes of care for persistent or chronic critical illness
Louise Rose, Laura Istanboulian, Craig Dale, Lisa Burry, Nicholas Hart, Clare Kydonaki, Pam Ramsay, Natalie Pattison, Bronwen Connolly, Laura Allum
Louise Rose, Laura Istanboulian, Craig Dale, Lisa Burry, Nicholas Hart, Clare Kydonaki, Pam Ramsay, Natalie Pattison, Bronwen Connolly, Laura Allum. Patient and family centered performance measures focused on actionable processes of care for persistent or chronic critical illness.
Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016052715
What processes of care and outcomes (including performance measures, quality indicators, and reports of patient/family experience) are reported in the current evidence base relevant to patients with persistent or chronic critical illness and their family members?
We will search electronic databases (March 1980 to Oct 2016): MEDLINE, CINAHL, EMBASE, and the Web of Science. We will search systematic review databases including the Cochrane Library, PROSPERO, and the Joanna Briggs Institute. We will search for clinical practice guidelines, policy documents, and professional society statements relevant to patients with CCI. We will examine reference lists of relevant studies/reviews for additional studies and will contact corresponding authors for details of additional published/unpublished work. We will search for unpublished and ongoing trials on the http://apps.who.int/trialsearch website. We will develop and refine search strategies with an experienced information specialist (librarian). Searches will be peer-reviewed according to the PRESS template before formally executed. We will develop our search for MEDLINE and adapt to other databases.
Types of study to be included
We will include all study designs except case series/reports of <5 patients. We will examine reviews and opinion papers for additional processes of care and outcomes perceived of relevance to our population of interest. We will exclude commentaries and editorials, and for pragmatic reasons studies reported in languages other than English.
Condition or domain being studied
Patients are considered to have persistent or chronic critical illness when recovered from the acute critical illness necessitating ICU admission but neither improve, recover, nor die and continue to require protracted ICU admission. These patients experience ongoing dependency on resource-intensive ICU therapies, protracted acute care hospital and other healthcare facility stays, and ongoing physical and cognitive deficits resulting in a difficult and prolonged course of recovery. Patients with CCI experience a syndrome of ongoing organ dysfunction, profound weakness and extreme symptom burden. Family members also experience significant physical and psychological burden associated with ICU admission, including anxiety, depression, and post-traumatic stress disorder that arguably require an enhanced level of support.
We will include studies describing their study population (aged 16 years and older) using terms such as persistent and chronic critical illness or prolonged mechanical ventilation. Based on previous experience with this literature, we are aware such terms are highly variable in the definition of mechanical ventilation duration or ICU length of stay. Therefore we will include only studies that report on a cohort with an ICU length of stay of seven days or more as an inclusion criteria for the study (not as the mean or median duration of stay of the cohort). We have selected this definition based on the consensus definition used by Medicare and Medicaid. Additionally we will include studies reporting on family members of patients experiencing persistent or chronic critical illness.
We will exclude studies describing a long-term mechanical ventilation population defined as patients with no expectation of weaning, and studies describing patient cohorts receiving mechanical ventilation at home.
Inclusion criteria for the primary exposure of interest include:
(1) ICU length of stay of seven days or more;
(2) Considered to be experiencing persistent or chronic critical illness or prolonged mechanical ventilation (as a synonym for persistent/chronic critical illness) by study authors; and
(3) Admitted to long term acute care hospital (LTACH), specialized weaning centre or respiratory step-down unit following an ICU length of stay of seven days or more.
Exclusion criteria include long-term mechanical ventilation outside of an ICU, specialized weaning centre or respiratory step down unit, as well as home mechanical ventilation.
There is no comparator/control for this review.
Our primary outcome is to determine actionable processes of care deemed relevant to patients experiencing persistent or chronic critical illness and their family members.
Secondary outcomes include:
(1) performance measures and quality indicators considered relevant to patients experiencing persistent or chronic critical illness and their family members;
(2) themes related to patient and family experience; and
(3) study outcomes.
Data extraction, (selection and coding)
Using a pre-designed screening tool, two authors will independently examine study titles and abstracts. We will obtain full text articles considered potentially relevant by either author and examine for eligibility. Disagreements will be resolved through third author discussion. Two authors in pairs will independently extract study data using a standardized form; all data extraction will be checked for accuracy by a third author. We will extract data on the country(ies) study performed, care venue type, age range, diagnostic categories, ventilation duration and ICU LOS, verbatim description of care processes, performance measures, quality indicators, study outcomes measured, and when relevant themes related to patient and family experience.
Risk of bias (quality) assessment
Two investigators will assess independently risk of bias using the Cochrane Risk of Bias tool for randomized and quasi-randomized studies and the Cochrane Robin-I tool for non-randomized studies. For qualitative studies, two authors will independently appraise study quality using the ten questions of the 2014 Critical Appraisal Skills Programme (CASP) quality assessment tool for qualitative studies. Assessment of bias will not influence data synthesis.
Strategy for data synthesis
We will summarize search results in a PRISMA study flow diagram. We will generate summary tables reporting counts and proportions of study, cohort, and care process/intervention characteristics, quality metrics and tools, themes/description of patient/family experience, and study outcomes. We will categorize potential quality metrics using the conceptual framework of structure, process, and outcomes. We will generate descriptive statistics using SPSS Version 23 (Armonk, NY).
Analysis of subgroups or subsets
We will disseminate our findings through peer-reviewed and open access publications, and presentations at international conferences purposefully selected to reach a wide range of knowledge users taking into account geographic locations. We will provide a one page summary (clinicians/researchers and in lay language for patients and families) to relevant organizations including patient advocacy groups and professional societies for distribution among their members and networks and will engage with them to seek additional opportunities to present our findings (educational seminars/workshops).
Contact details for further information
155 College St, Toronto, ON, Canada, M5T 1P8
Organisational affiliation of the review
Dr Louise Rose, University of Toronto Ms Laura Istanboulian, Michael Garron Hospital Dr Craig Dale, University of Toronto Dr Lisa Burry, Mt Sinai Hospital Dr Nicholas Hart, Guys and St Thomas's Hospital Trust Dr Clare Kydonaki, Napier University Dr Pam Ramsay, Napier University Dr Natalie Pattison, The Royal Marsden Hospital Dr Bronwen Connolly, Guys and St Thomas's Hospital Trust Ms Laura Allum, Guys and St Thomas's Hospital Trust
Dr Andre Amaral, Sunnybrook Health Sciences Centre Dr Eddy Fan, Toronto General Hospital Dr Shannon Carson, University of North Carolina Dr Christopher Cox, Duke University Hospital Dr Jack Iwashyna, University of Michigan Dr Brian Cuthbertson, Sunnybrook Health Sciences Centre
Anticipated or actual start date
16 December 2016
Anticipated completion date
22 December 2017
This review is being supported by a research grant from the Michael Garron Hospital Community Based Research Fund
Conflicts of interest
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Chronic Disease; Critical Illness; Humans; Patient-Centered Care
Stage of review
Date of registration in PROSPERO
31 December 2016
Date of publication of this revision
31 December 2016
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.