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中华重症医学电子杂志 ›› 2026, Vol. 12 ›› Issue (01) : 46 -51. doi: 10.3877/cma.j.issn.2096-1537.2026.01.009

学科建设

质量注册、标杆分析与同质化:重症医学质量改进的核心路径
邱昱1, 席修明2,()   
  1. 1 100050 北京,首都医科大学附属北京友谊医院ICU
    2 100038 北京,首都医科大学附属复兴医院ICU
  • 收稿日期:2025-04-21 出版日期:2026-02-28
  • 通信作者: 席修明

Quality registries, benchmarking and homogenization: core pathways to quality improvement in intensive care medicine

Yu Qiu1, Xiuming Xi2,()   

  1. 1 Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
    2 Department of Intensive Care Unit, Fuxing Hospital, Capital Medical University, Beijing 100038, China
  • Received:2025-04-21 Published:2026-02-28
  • Corresponding author: Xiuming Xi
引用本文:

邱昱, 席修明. 质量注册、标杆分析与同质化:重症医学质量改进的核心路径[J/OL]. 中华重症医学电子杂志, 2026, 12(01): 46-51.

Yu Qiu, Xiuming Xi. Quality registries, benchmarking and homogenization: core pathways to quality improvement in intensive care medicine[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2026, 12(01): 46-51.

重症医学的质量改进依赖于质量注册、标杆分析与同质化构成的协同框架,其中质量注册通过系统化数据收集建立真实世界数据库,为质量监测提供基础;标杆分析通过跨机构绩效对比识别差距并优化临床实践;同质化则通过统一诊疗标准确保改进措施的广泛适用性,三者共同形成“数据采集-差距识别-标准落地”的闭环管理体系。这一协同路径既保持了标准化的规模效应,又支持个体化精准干预,通过将真实世界研究转化为临床实践创新,有效缩小不同医疗机构间的质量差异,最终实现以患者临床结局为导向的重症医学高质量发展,持续推动优化医疗行为和改善患者预后。本文系统阐述这一框架的理论基础、技术路径与实践案例,并探讨其未来发展方向。

Quality improvement in intensive care medicine relies on a synergistic framework composed of quality registries, benchmarking, and homogenization. Quality registries establish real-world databases through systematic data collection, providing the foundation for continuous quality surveillance. Benchmarking compares performance across institutions to identify gaps and optimize clinical practice. Homogenization standardizes diagnostic and therapeutic protocols to ensure broad applicability of improvement measures. Together, these elements form a closed-loop management cycle of "data collection – gap identification – standard implementation." This synergistic pathway preserves the economies of scale inherent in standardization while supporting individualized, precise interventions. By translating real-world research into clinical practice innovation, it narrows quality disparities among healthcare facilities and ultimately advances high-quality, outcome-oriented intensive care medicine, continually optimizing clinical processes and improving patient prognosis. This article systematically elaborates on the theoretical basis, technical approach and practical cases of this framework, and also explores its future development direction.

图1 质量改进闭环体系——“铁三角”协同框架
图2 临床质量控制指标类型
1
Demass TB, Guadie AG, Mengistu TB, et al. The magnitude of mortality and its predictors among adult patients admitted to the Intensive care unit in Amhara Regional State, Northwest Ethiopia [J]. Sci Rep, 2023, 13(1): 12010.
2
Pisani L, Algera AG, Neto AS, et al. Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies [J]. Lancet Glob Health, 2022, 10(2): e227-e235.
3
Moin EE, Seewald NJ, Halpern SD. Use of life support and outcomes among patients admitted to intensive care units [J]. JAMA, 2025, 333(20): 1793-1803.
4
Dongelmans DA, Pilcher D, Beane A, et al. Linking of global intensive care (LOGIC): an international benchmarking in critical care initiative [J]. J Crit Care, 2020, 60: 305-310.
5
Liu VX, Morehouse JW, Marelich GP, et al. Multicenter implementation of a treatment bundle for patients with sepsis and intermediate lactate values [J]. Am J Respir Crit Care Med, 2016, 193(11): 1264-1270.
6
Roos-Blom MJ, Bakhshi-Raiez F, Brinkman S, et al. Quality improvement of Dutch ICUs from 2009 to 2021: a registry based observational study [J]. J Crit Care, 2024, 79: 154461.
7
Wortel SA, de Keizer NF, Abu-Hanna A, et al. Number of intensivists per bed is associated with efficiency of Dutch intensive care units [J]. J Crit Care, 2021, 62: 223-229.
8
Litton E, Guidet B, de Lange D. National registries: lessons learnt from quality improvement initiatives in intensive care [J]. J Crit Care, 2020, 60: 311-318.
9
Brooke EM. The current and future use of registers in health information systems [M]. Geneva: World Health Organization, 1974.
10
Kaukonen KM, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012 [J]. JAMA, 2014, 311(13): 1308-1316.
11
Gliklich RE, Leavy MB, Dreyer NA. Registries for Evaluating Patient Outcomes: A User's Guide [M/OL]. 4th ed. Rockville: Agency for Healthcare Research and Quality, 2020.
12
Soares M, Borges LP, Bastos L, et al. Update on the Epimed monitor adult ICU database: 15 years of its use in national registries, quality improvement initiatives and clinical research [J]. Crit Care Sci, 2024, 36: e20240150en.
13
Hoque DME, Kumari V, Hoque M, et al. Impact of clinical registries on quality of patient care and clinical outcomes: a systematic review [J]. PLoS One, 2017, 12(9): e0183667.
14
Woodhouse D, Berg M, van der Putten J, et al. Will benchmarking ICUs improve outcome? [J]. Curr Opin Crit Care, 2009, 15(5): 450-455.
15
Samanta RJ, Ercole A, Harris S, et al. Low tidal volume ventilation is poorly implemented for patients in North American and United Kingdom ICUs using electronic health records [J]. Chest, 2024, 165(2): 333-347.
16
Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update [J]. Infect Control Hosp Epidemiol, 2014, 35(Suppl 2): S133-154.
17
Salluh JIF, Soares M, Keegan MT. Understanding intensive care unit benchmarking [J]. Intensive Care Med, 2017, 43(11): 1703-1707.
18
Al-Dorzi HM, Arabi YM. Quality indicators in adult critical care medicine [J]. Glob J Qual Saf Healthc, 2024, 7(2): 75-84.
19
Rothen HU, Stricker K, Einfalt J, et al. Variability in outcome and resource use in intensive care units [J]. Intensive Care Med, 2007, 33(8): 1329-1336.
20
Takala J, Moser A, Raj R, et al. Variation in severity-adjusted resource use and outcome in intensive care units [J]. Intensive Care Med, 2022, 48(1): 67-77.
21
Phua J, Koh Y, Du B, et al. Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study [J]. BMJ, 2011, 342: d3245.
22
Checkley W, Brower R, Korpak A, et al. Effects of a clinical trial on mechanical ventilation practices in patients with acute lung injury [J]. Am J Respir Crit Care Med, 2008, 177(11): 1215-1222.
23
Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over time in patients receiving mechanical ventilation [J]. Am J Respir Crit Care Med, 2013, 188(2): 220-230.
24
Levy MM, Gesten FC, Phillips GS, et al. Mortality changes associated with mandated public reporting for sepsis. The results of the New York State Initiative [J]. Am J Respir Crit Care Med, 2018, 198(11): 1406-1412.
25
Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure [J]. Crit Care Med, 2008, 36(8): 2238-2243.
26
Rui X, Dong F, Ma X, et al. Quality metrics and outcomes among critically ill patients in China: results of the national clinical quality control indicators for critical care medicine survey 2015-2019 [J]. Chin Med J (Engl), 2022, 135(9): 1064-1075.
27
Barr J, Downs B, Ferrell K, et al. Improving outcomes in mechanically ventilated adult ICU patients following implementation of the ICU Liberation (ABCDEF) bundle across a large healthcare system [J]. Crit Care Explor, 2024, 6(1): e1001.
28
He H, Chi Y, Yang Y, et al. Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial [J]. Crit Care, 2021, 25(1): 230.
29
Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution [J]. Lancet Glob Health, 2018, 6(11): e1196-e1252.
30
Beane A, Salluh JIF, Haniffa R. What intensive care registries can teach us about outcomes [J]. Curr Opin Crit Care, 2021, 27(5): 537-543.
31
Johnson AEW, Bulgarelli L, Shen L, et al. MIMIC-Ⅳ, a freely accessible electronic health record dataset [J]. Sci Data, 2023, 10(1): 1.
32
Paragliola G, Ribino P, Ullah Z. A federated learning approach to support the Decision-Making Process for ICU patients in a European Telemedicine Network [J]. J Sens Actuator Netw, 2023, 12(6): 78.
33
Kruk ME, Gage AD, Joseph NT, et al. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries [J]. Lancet, 2018, 392(10160): 2203-2212.
34
Hashmi M, Beane A, Taqi A, et al. Pakistan Registry of Intensive CarE (PRICE): expanding a lower middle-income, clinician-designed critical care registry in South Asia [J]. J Intensive Care Soc, 2019, 20(3): 190-195.
35
van de Klundert N, Holman R, Dongelmans DA, et al. Data resource profile: the Dutch National Intensive Care Evaluation (NICE) registry of admissions to adult intensive care units [J]. Int J Epidemiol, 2015, 44(6): 1850-1850h.
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