A nationwide analysis of intensive care unit admissions, 2009–2014 – The Korean ICU National Data (KIND) study

Park, Jinkyeong; Jeon, Kyeongman; Chung, Chi Ryang; Yang, Jeong Hoon; Cho, Yang Hyun; Cho, Joongbum; Park, Chi Min; Park, Hye Jeong; Cho, Juhee; Güallar, Eliseo; Suh, Gee Young

doi:10.1016/j.jcrc.2017.09.017

Cited by 57 publications

(60 citation statements)

References 32 publications

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“…However, one needs to be cautious in saying there were no healthcare disparities in the ICU. The overall inhospital mortality rate of children might be too low to identify a disparity compared to adult patients [13,29]. Furthermore, healthcare disparities might exist in some subgroups of ICU patients.…”

Section: Discussionmentioning

confidence: 99%

Health Disparities of Critically Ill Children in Poverty: A Nationwide Population-Based Study

Park¹,

Park²,

Kang³

et al. 2020

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Background: There is a lack of nationwide studies on health disparity of critically ill patients under the National Health Insurance (NHI) System. We aim to evaluate health disparities in intensive care unit (ICU) admission, outcomes, and readmission after ICU discharge in an impoverished pediatric population.Methods: We conducted a retrospective cohort study using a national database of claims submitted to the Korean NHI and Medical Aid Program (MAP). MAP provides support for the population whose household income is lower than 40% of the median Korean household income, and we defined poverty as being a MAP beneficiary. Patients between 28 days and 18 years old who were admitted to the ICU between August 1, 2010 and September 30, 2013, were included. Demographic characteristics, procedures, admission rates, and clinical outcomes were compared between the poverty and reference groups. Logistic regression model used to analyze hospital mortality and readmission with adjustment for patient characteristics, hospital type, and management procedures.Results: Out of 17,893 patients, 1,153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There were more deaths among impoverished patients who were admitted to the ICU (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group had a similar risk of adjusted in-hospital mortality to those not in the poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42).Conclusion: Pediatric patients in poverty were more likely to die in association with ICU admission. A high ICU admission rate rather than the high in-hospital mortality rate may cause the disparity in deaths. Further policies and studies are required to improve the health status of pediatric patients in poverty to decrease ICU admission.Trial registration: retrospectively registered

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Section: Discussionmentioning

confidence: 99%

Health Disparities of Critically Ill Children in Poverty: A Nationwide Population-Based Study

Park¹,

Park²,

Kang³

et al. 2020

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“…As the global population ages, growing numbers of elderly and very elderly patients are being admitted to intensive care units (ICUs) or intermediate care units (IMCUs) (1) (2). Age has generally been thought to have a strong association with intensive and intermediate care outcomes, with older patients having a poorer prognosis than younger ones (3) (4).…”

Section: Introductionmentioning

confidence: 99%

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit.

D'Andrea

Peillet²,

Fassier³

et al. 2020

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Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU).MethodsA monocentric, retrospective, observational study of all patients aged ≥ 75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables.Results A total of 345 patients were included (56% female, mean age 85 +/- 6.5 years). Mean FIM score was 66 +/- 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68% and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores.Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.

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“…With population aging and the increase in chronic diseases, the number of patients in intensive care units (ICUs) has been increasing (Halpern & Stephen, ; Park et al, ). However, mortality in the ICU is declining, with more than 80% of patients being discharged (Hill et al, ; Zimmerman, Kramer, & Knaus, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…There has been an increase in the number of critical care studies using long-term nationwide big data (Davydow, Hough, Langa, & Iwashyna, 2013;Park et al, 2018). Since Korea has achieved universal healthcare coverage, data related to the use of medical institutions and pharmacies by almost all citizens are stored and managed by the National Health Insurance Service (NHIS) (Lee, Kim, & Lee, 2012).…”

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confidence: 99%

Post‐intensive care unit depression among critical care survivors: A nationwide population‐based study

Kang

Yun

Cho

et al. 2019

Japan Journal Nursing Sci

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Aim To investigate the incidence of post‐intensive care unit (ICU) depression and its risk factors among critical care survivors. Methods The study data were extracted from the database of the National Health Insurance Service of Korea. We retrospectively analyzed data from 161,977 adult patients who were admitted to the ICU for more than 24 hr from January 1, 2012 to December 31, 2014 and survived for more than 1 year after discharge. Risk factors for newly diagnosed depression (Code F32) were analyzed using multiple logistic regression analysis. Results The incidence of post‐ICU depression was 18.5%. The major risk factors were enteral nutrition (odds ratio [OR] = 2.28, 95% confidence interval [CI] = 2.19–2.36), cerebrovascular disease (OR = 1.59, 95% CI = 1.54–1.64), and hemi/paraplegia (OR = 1.48, 95% CI = 1.41–1.56). It was observed that cardiopulmonary resuscitation (OR = 0.55, 95% CI = 0.50–0.61) and myocardial infarction (OR = 0.75, 95% CI = 0.71–0.79) lowered depression. Conclusions The incidence of post‐ICU depression was high and influenced by ICU treatment and physical impairments. Healthcare providers must pay attention to the psychological changes in survivors with major risk factors in the recovery process.

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A nationwide analysis of intensive care unit admissions, 2009–2014 – The Korean ICU National Data (KIND) study

Cited by 57 publications

References 32 publications

Health Disparities of Critically Ill Children in Poverty: A Nationwide Population-Based Study

Health Disparities of Critically Ill Children in Poverty: A Nationwide Population-Based Study

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit.

Post‐intensive care unit depression among critical care survivors: A nationwide population‐based study

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