Top data repository headed for an overhaul
SCCM database will be easier to use
The critical care industry's chief data collection and benchmarking project is hoping to expand its membership - and its usefulness - with implementation of an automated data entry system next year.
Project IMPACT, developed by the Society of Critical Care Medicine (SCCM) in Anaheim, CA, has been in operation since February 1996. Currently there are 40 participating critical care units in the United States and internationally. Those units collect data on each patient admitted to their critical care units and download that information into IMPACT's central repository. In return, the units receive quarterly confidential reports that compare each unit's data on patient demographics, diagnoses, treatments, resource consumption, complications, and outcomes, with data from similar participating hospitals, ICUs, and specialties.
These benchmarking data provide the basis for internal assessment of procedures and performance and development of effective responses. Information gleaned from reports "can be used locally to institute improvements within the ICU," says Meg Wilson, general manager of Project IMPACT since July 1995.
Implementation of the automated data entry system is part of a three-stage upgrade of IMPACT's software and database designed to extend the reach of the project. A key element of the upgrade is due next year in the form of new software that will interface existing systems already in place in individual ICUs. That will eliminate the need for entry of data directly into IMPACT programs; instead, data already in the ICU's system can be downloaded directly.
"Right now, we are using a proprietary data system. It's not cohesive with other systems," says Wilson. The new IMPACT system will "reduce the burden of data being collected and entered manually," Wilson says.
Enrolling 40 ICUs in two years has been a notable accomplishment, Wilson says, but simplifying the data collection and entry process should open Project IMPACT participation to many more units. "The local resources needed to enter the data is the biggest stumbling block," she adds.
"I would love to have every ICU nationwide participating. Then units could do local benchmarking, and we would have true comparisons with national benchmarks," she says.
Expansion of IMPACT through recruitment of additional critical care units and thus collection of data on more patients, is key to future uses of the project for analysis of ICU outcomes. Records for some 20,00 patients are now in the central repository. "We will be the primary source of information once we have enough patient records in central repository," Wilson says.
Using IMPACT's quarterly reports, participating units can look at subsets of patients; analyze practice patterns, utilization of services, and patient outcomes; initiate quality of care improvements; and over a period of about six months, compare the results with their previous performances. "They can see what changes in outcomes have been accomplished," Wilson says.
The ultimate goal is improved patient care and reduced length of stay, costs, and use of resources, she says. While Project IMPACT data have been used to initiate quality improvements in individual ICUs (see related story, below right), the project has not been used for development of critical care treatment protocols or guidelines, Wilson says.
The data and analysis derived from Project IMPACT are becoming increasingly important with the growth in managed care, Wilson says. In some cases, Project IMPACT data may support quality of care initiatives by documenting outcomes and supporting changes in clinical practice.
In other cases, the documentation from IMPACT may be used by individual units in competitive bidding for managed care contracts.
"And it can serve as an accountability database as well," Wilson says, supporting internal cost and quality assessments. With ICUs typically comprising 25% to 30% of an acute care center's operating budget, cost containment achieved through use of IMPACT can be beneficial to a facility's finances.
And IMPACT can also help ICUs meet the new requirement from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), effective as of March 31, that facilities adopt a performance measurement system as part of the accreditation process. IMPACT meets the criteria as an acceptable system, and project management is committed to meeting any future JCAHO criteria.
Individual companies, for example, the pharmaceutical industry, can also tap the Project IMPACT data repository to address issues of interest. Data analysis, limited to protect the confidentiality of sources, is provided to subscribers to answer specific questions.
Annual fees for Project IMPACT participation are $2,000 per unit for the user software and $350 per licensed ICU bed. Total fees for a typical ICU of about 12 beds would be about $6,200.
The project requires IBM-compatible hardware with 16 or more megabytes of RAM and 200 megabytes and up of hard drive capacity for the file server. Individual workstations have separate copies of the IMPACT program and supporting files that connect to the file server, thus minimizing computer storage consumption on the workstation.
Individual workstations require eight megabytes of RAM and five megabytes of hard drive capacity to run the Project IMPACT program.
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