Critical care at the end of life: a population-level cohort study of cost and outcomes

Abstract

BackgroundDespite the high cost associated with ICU use at the end of life, very little is known at a population level about the characteristics of users and their end of life experience. In this study, our goal was to characterize decedents who received intensive care near the end of life and examine their overall health care use prior to death.MethodsThis was a retrospective cohort study that examined all deaths in a 3-year period from April 2010 to March 2013 in Ontario, Canada. Using population-based health administrative databases, we examined healthcare use and cost in the last year of life.ResultsThere were 264,754 individuals included in the study, of whom 18% used the ICU in the last 90 days of life; 34.5% of these ICU users were older than 80 years of age and 53.0% had more than five chronic conditions. The average cost of stay for these decedents was CA$15,511 to CA$25,526 greater than for those who were not admitted to the ICU. These individuals also died more frequently in hospital (88.7% vs 36.2%), and spent more time in acute-care settings (18.7 days vs. 10.5 days).ConclusionsWe showed at a population level that a significant proportion of those with ICU use close to death are older, multi-morbid individuals who incur significantly greater costs and die largely in hospital, with higher rates of readmission, longer lengths of stay and higher rates of aggressive care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1711-4) contains supplementary material, which is available to authorized users.

Emergency Department disposition decisions and associated mortality and costs in ICU patients with suspected infection

“…The Ottawa Hospital uses a standardized case-costing methodology that was developed by the Ontario Case Costing Initiative and is based on the Canadian Institute for Health Information Management Information Systems guidelines [ 22 ]. Costs were then indexed (to 2018 Canadian dollars) using consumer price indices [ 13 , 23 , 24 ].…”

Analyzing Outcomes Among Older Adults With Necrotizing Soft-Tissue Infections in the United States

“…It is difficult to conclude this from our study, as the database is not granular enough to determine severity, but it is known the additional medications, personnel, and technology to manage a patient at the end of life is more costly. 26 In addition, if a patient developed a complication while in the hospital, their associated health-care costs almost doubled. Again, this makes sense given the nature of receiving more care correlating directly with increased costs.…”

Prevalence of Having Advance Directives and a Signed Power of Attorney in Nova Scotia

“…After adjusting for characteristics of both the decedent and their informants, being provided with specialized palliative care made the largest difference in decedents' odds of having an AD. Given the substantial costs of acute care-focused end-of-life care to the system [32][33][34][35][36][37] and to patients and their loved ones, 35,38 this new evidence adds to the case for AD promotion as a means to provide more positive health-care experiences for dying patients and their loved ones while freeing up scarce health-care resources for other potential uses. In addition, these results provide a demographic profile of Nova Scotians for who efforts to promote AD use to date may have been relatively successful (i.e., those who are aged 85 or older and/or those living in nursing homes) versus relatively unsuccessful (i.e., those receiving the majority of their care in nonpalliative hospital settings, those who have not had postsecondary education and those whose nextof-kin are aged 65 or older).…”