Recently published in the scientific journal Critical Care Medicine, a review led by the D'Or Institute for Research and Education (IDOR) shed light on the importance of clinical quality registries (CQRs) for the healthcare sector. Also known as electronic medical records, CQRs are systems for collecting and storing health information related to patients and their treatments. The publication includes the collaboration of 15 countries' institutions and shows how the qualified collection of clinical and administrative information has been relevant for optimizing healthcare and management in intensive care units (ICUs).
ICU data for epidemiological maps and scientific research
In addition to being an extraordinary resource for optimizing healthcare, CQRs are also a valuable basis for developing research. Records collected in different health units in different states and countries become a large epidemiological map, allowing a better understanding of regions that are vulnerable to certain diseases, or even highlighting treatment protocols that have better effect than others.
For more than three decades, national records of ICUs have been collected by countries around the world to improve results and the use of resources in these critical care units. In Brazil, the Brazilian ICUs project, led by the Brazilian Intensive Care Medicine Association (AMIB), has a database of more than 4 million ICU admissions.
"The so-called 'ICU records' are rich sources for understanding the variety of diseases within ICUs, allowing the characterization of the critically ill patient population. Furthermore, this information also allows for better management of the resources and improvement of quality care", comments one of the authors of the review, Dr. Amanda Quintairos, who is a doctoral candidate at IDOR, manager, and intensive care physician at Hospital Porto Dias, in Belém, Brazil, and coordinator of the National Registry of Colombian ICUs.
The review confirms the role of these registries in providing patient demographics, variables, and ICU outcome indicators. ICU CQRs provide information on trends in infectious agents, mortality rates, real-world data, and the impact of different hospital interventions on clinical outcomes. With this information, we can also better understand the chain of processes and secondary results in the treatment of important diseases that affect critically ill patients, such as sepsis, acute respiratory distress syndrome, pneumonia, ischemic stroke, and acute myocardial infarction.
"If we take the COVID-19 vaccination as an example, in another study we developed, these records were able to demonstrate the effectiveness of the immunization campaign by reducing the patient mortality curve. We also had other data that reiterated this, such as a reduction in mechanical ventilation requirement", illustrates the intensivist, adding that this data also facilitates clinical research, as it already offers researchers files detailing risk groups, mortality, and incidence of many diseases, facilitating patient recruitment.
Comparing ICUs from around the world
The publication shows that the use of RQCs is also very important for benchmarking strategies between different hospitals and clinical centers. According to Dr. Quintairos, this comparison is relevant not from a competitive point of view, but because it offers the possibility of optimizing and managing the units' resources.
"When we don't compare a service with others in the same area, we run the risk of making two mistakes. The first is thinking that we are providing a great service, when in fact we have many opportunities for improvement. And the second error is the opposite, when we are not aware of providing an excellent service, which prevents us from reinforcing strategies that are giving great results and seeing our strengths", adds the researcher.
Another point highlighted by Quintairos is that the use of data in the management of medical care leaves less room for assumptions, offering more accurate information about epidemiological profiles and the quality of services provided, whether in the public or private sector, or in different regions. This data can be analyzed by different performance metrics, through scores, mortality rates, and quality of care, among many others.
Challenges and Opportunities of CQRs
Despite all its usefulness and relevance for healthcare assistance and research, CQRs still face considerable challenges regarding financing, data governance, security, and quality assurance, as well as transparency in the collected information.
To overcome these challenges, joint efforts are essential across the scientific community, and many international protocols have already been created to adequately capture this information. In developing countries, important initiatives are also taking place to standardize quality indicators in ICUs, which encourages the possibility of a global understanding of effective interventions and comparative health data.
"In Brazil, we still have a challenge regarding organizational culture. Institutions are moving towards acquiring this maturity in data collection and adopting strategic planning centered on this information. However, we still see management based on the doctors' intuition and experience. We need to increasingly disseminate data-based management", adds the researcher.
Even with their funding challenges, CQRs are already presenting a revolution in healthcare and research. The large volume of data is also a great opportunity for the implementation of artificial intelligence (AI) algorithms, an opportunity that IDOR is already exploring in several other studies through machine learning and natural language processing (NLP).
The current review brings visibility to the growing role of CQRs in modernizing and improving healthcare systems by providing effective means of collecting, storing and sharing medical information. The large database offered by these registries also has great transformative potential, bringing improvements in the quality and safety of medical care, and offering patients the benefits of a more efficient and evidence-based care.
