A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

Across 5-year follow-up, nearly one-third of previously employed ARDS survivors never returned to work. Delayed return to work was associated with patient-related and intensive care unit/hospital-related factors, substantial lost earnings and a marked rise in government-funded healthcare coverage. These important consequences emphasise the need to design and evaluate vocation-based interventions to assist ARDS survivors return to work.

Objective To evaluate the time-varying relationship of annual physical, psychiatric, and quality of life status with subsequent inpatient health care resource use and estimated costs. Design 5-year longitudinal cohort study Setting 13 ICUs at four teaching hospitals Patients 138 patients surviving ≥2 years after ARDS Interventions None Measurements and Main Results Post-discharge inpatient resource use data (e.g., hospitalizations, skilled nursing, and rehabilitation facility stays) were collected via a retrospective structured interview at 2 years, with prospective collection every 4 months thereafter, until 5 years post-ARDS. Adjusted odds ratios for hospitalization and relative medians for estimated episode of care costs were calculated using marginal longitudinal two-part regression. The median (interquartile range [IQR]) number of inpatient admissions hospitalizations was 4 (2 – 8), with 114 (83%) patients reporting ≥1 hospital readmission. The median (IQR) estimated total inpatient post-discharge costs over 5 years were $58,500 ($19,700–$157,800, 90th percentile: $328,083). Better annual physical and quality of life status, but not psychiatric status, were associated with fewer subsequent hospitalizations and lower follow-up costs. For example, greater grip strength (per 6 kg) had an odds ratio (95% confidence interval) of 0.85 (0.73–1.00) for inpatient admission, with 23% lower relative median costs, 0.77 (0.69–0.87). Conclusions In a multi-site cohort of long-term ARDS survivors, better annual physical and quality of life status, but not psychiatric status, were associated with fewer hospitalizations and lower health care costs.

In this multisite study of 138 two-year survivors of ALI, 80% had one or more inpatient admission, representing a median (IQR) estimated cost $35,259 ($10,565-$81,166) per patient and $6,598,766 for the entire cohort. Hospital readmissions represented 76% of total inpatient costs, and having Medicare or Medicaid before ALI was associated with increased costs. With the aging population and increasing comorbidity, these findings have important health policy implications for the care of critically ill patients.

Rehabilitation interventions, including physiotherapy and occupational therapy, can improve patient outcomes; however, the optimal duration and frequency of inpatient rehabilitation interventions is uncertain. In a recent randomized controlled trial published in BMC Medicine, 996 patients in two publicly-funded Australian metropolitan rehabilitation facilities were assigned to physiotherapy and occupational therapy delivered Monday through Friday (five days/week control group) versus Monday through Saturday (six days/week intervention group). This increased dose of rehabilitation in the intervention group resulted in greater functional independence and quality of life at discharge, with a trend towards significant improvement at six-month follow-up. Moreover, the length of stay for the intervention group was shorter by two days (95% CI 0 to 4, P = 0.10). Hence, in the acute inpatient rehabilitation setting, a larger dose of physiotherapy and occupational therapy, via six versus five days/week treatment, improves patient outcomes and potentially reduces overall length of stay and costs.Please see related research: http://www.biomedcentral.com/1741-7015/11/198.

Ever-increasing threats to cyber security present serious challenges for population health. However, the direct intersections between cyber security and public health can benefit from examination through the lenses of public health system operational frameworks. In this paper, we thus provide an overview of how cyber security issues may systemically impact public health emergency preparedness and imperil the delivery of essential public health services. We discuss future broad-based policy and research considerations accordingly for this critical public health security dimension.

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