Federal and nationwide intensive care units and healthcare costs: 1986-1992

Halpern, Neil A.; Bettes, Larry; Greenstein, Robert J.

doi:10.1097/00003246-199412000-00019

Cited by 97 publications

(71 citation statements)

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“…We focused on acute care hospitalizations because these constitute the biggest component of health resource use in industrialized countries. 11,17 Using hospital claims, we identified inpatient hospitalizations after excluding admissions related to pregnancy, respite, or long-term care because the factors associated with those admissions may differ from the factors associated with admissions for acute illness. To minimize double-counting of hospitalizations related to transfers between facilities for continued care, overnight hospitalizations beginning within 61 day of another hospital discharge with the same primary or secondary diagnosis codes were considered to be part of the same hospitalization.…”

Section: Standard Protocol Approvals Registrations and Patient Consmentioning

confidence: 99%

Comorbidity increases the risk of hospitalizations in multiple sclerosis

et al. 2015

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Objective: We aimed to evaluate the association between comorbidity and rates of hospitalization in the multiple sclerosis (MS) population as compared to a matched cohort from the general population.Methods: Using population-based administrative data from the Canadian province of Manitoba, we identified 4,875 persons with MS and a matched general population cohort of 24,533 persons. We identified all acute care hospitalizations in the period 2007-2011. Using general linear models, we evaluated the association between comorbidity status and hospitalization rates (all-cause, non-MS-related, MS-related) in the 2 populations, adjusting for age, sex, and socioeconomic status.Results: Comorbidity was common in both cohorts. Over the 5-year study period, the MS population had a 1.5-fold higher hospitalization rate (adjusted rate ratio [aRR] 1.56; 95% confidence interval [CI] 1.44-1.68) than the matched population. Any comorbidity was associated with a 2-fold increased risk of non-MS-related hospitalization rates (aRR 2.21; 95% CI 1.73-2.82) in the MS population, but a nearly 4-fold increase in hospitalization rates in the matched population (aRR 3.85; 95% CI 3.40-4.35). Comorbidity was not associated with rates of hospitalization for MS-related reasons, regardless of how comorbidity status was defined. Conclusions:In the MS population, comorbidity is associated with an increased risk of all-cause hospitalizations, suggesting that the prevention and management of comorbidity may reduce hospitalizations. Neurology ® 2015;84:350-358 GLOSSARY aRR 5 adjusted rate ratio; CI 5 confidence interval; ICD-9 5 International Classification of Diseases-9; MS 5 multiple sclerosis; PHIN 5 personal health identification number; RR 5 rate ratio; SES 5 socioeconomic status.Comorbidity is common in the multiple sclerosis (MS) population. Physical comorbidities, such as hypertension, affect more than one-third of persons with MS.1 Psychiatric comorbidities, such as depression, affect more than 50% of persons with MS over their lifetime.2 Comorbidity is associated with longer diagnostic delays and greater disability at diagnosis and lower quality of life in MS. 3,4 The impact of comorbidity on health care utilization in MS is unknown, but is identified as a key knowledge gap for clinicians and decision-makers.5 Health care utilization is high in the MS population, 6 with up to 25.8% of the MS population being hospitalized annually, 7 exceeding the rate of hospitalizations in the general population. 8 The mean number of physician visits per year is also higher in the MS population.9 In other diseases, persons with multiple chronic health conditions have higher rates of health care utilization than persons with a single condition. 10Hospitalizations constitute the largest component of resource use in Canada and other industrialized countries, 11 and costs of hospitalizations for MS are rising. 12 In other chronic diseases, comorbidity is often undertreated, 13 potentially leading to increased hospitalizations. Therefore, we aimed to e...

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Section: Standard Protocol Approvals Registrations and Patient Consmentioning

confidence: 99%

Comorbidity increases the risk of hospitalizations in multiple sclerosis

et al. 2015

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“…[1][2][3][4] While chronic diseases are established risk factors for ICU admission and mortality, 5,6 little is known about the influence of immune-mediated diseases such as multiple sclerosis (MS) on ICU admissions. MS is associated with increased risks of infection 7 and ischemic heart disease, 8,9 which could increase the risk of ICU admission.…”

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confidence: 99%

Intensive care unit admission in multiple sclerosis

et al. 2014

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Objective: To compare the incidence of, and mortality after, intensive care unit (ICU) admission as well as the characteristics of critical illness in the multiple sclerosis (MS) population vs the general population.Methods: We used population-based administrative data from the Canadian province of Manitoba for the period 1984 to 2010 and clinical data from 93% of admissions to provincial high-intensity adult ICUs. We identified 5,035 prevalent cases of MS and a cohort from the general population matched 5:1 on age, sex, and region of residence. We compared these populations using incidence rates and multivariable regression models adjusting for age, sex, comorbidity, and socioeconomic status.Results: From January 2000 to October 2009, the age-and sex-standardized annual incidence of ICU admission among prevalent cohorts was 0.51% to 1.07% in the MS population and 0.34% to 0.51% in matched controls. The adjusted risk of ICU admission was higher for the MS population (hazard ratio 1.45; 95% confidence interval [CI] 1.19-1.75) than for matched controls. The MS population was more likely to be admitted for infection than the matched controls (odds ratio 1.82; 95% CI 1.10-1.32). Compared with the matched controls admitted to ICUs, 1-year mortality was higher in the MS population (relative risk 2.06; 95% CI 1.32-3.07) and was particularly elevated in patients with MS who were younger than 40 years (relative risk 3.77; 95% CI 1.45-8.11). Causes of death were MS (9.3%), infections (37.0%), and other causes (52.9%). Conclusions:Compared with the general population, the risk of ICU admission is higher in MS, and 1-year mortality after admission is higher. Greater attention to preventing infection and managing comorbidity is needed in the MS population. Neurology ® 2014;82:2112-2119 GLOSSARY APACHE II 5 Acute Physiology and Chronic Health Evaluation II; CCI 5 Charlson Comorbidity Index; CI 5 confidence interval; HR 5 hazard ratio; ICD-9-CM 5 International Classification of Diseases, ninth revision, Clinical Modification; ICD-10 5 International Classification of Diseases, tenth revision; ICU 5 intensive care unit; IRR 5 incidence rate ratio; MS 5 multiple sclerosis; OR 5 odds ratio; SES 5 socioeconomic status.Intensive care units (ICUs) are an important component of hospital care, consuming a disproportionate share of medical costs in industrialized countries.1-4 While chronic diseases are established risk factors for ICU admission and mortality, 5,6 little is known about the influence of immune-mediated diseases such as multiple sclerosis (MS) on ICU admissions. MS is associated with increased risks of infection 7 and ischemic heart disease, 8,9 which could increase the risk of ICU admission. However, hospitalized elderly patients with MS have been reported to be less likely to use intensive or coronary care services than other patients. 10 The risk of ICU admission in the nonelderly MS population has not been studied, and outcomes after ICU admission are largely unknown.11 Knowledge of the characteristics and out...

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“…This topdown principle has been used to estimate the cost of intensive care outside the UK [26,27]. It is attractive because laborious costing of individual patients is avoided.…”

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confidence: 99%

The development of a method for comparative costing of individual intensive care units

et al. 1999

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SummaryIntensive care is one of the most costly areas of hospital care. Unfortunately, because of the diversity of case mix, costing intensive care is difficult. Many described costing methods previously are limited by being cumbersome, laborious to apply and expensive. The aim of this study was to develop a method for costing intensive care which can be applied with ease but facilitate meaningful cost comparisons between intensive care units. The method developed was based on cost blocks where the major components were identified and costed in a 'top-down' manner. Using strict definitions, the cost blocks attempted to measure the costs of equipment, estates, nonclinical support services (such as hospital management costs), clinical support services (such as physiotherapy, laboratory services), consumables (such as drugs, fluids and disposables) and staff. The study found that clinical support services, consumables and staff costs accounted for approximately 85% of the total costs.

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Federal and nationwide intensive care units and healthcare costs: 1986-1992

Cited by 97 publications

References 0 publications

Comorbidity increases the risk of hospitalizations in multiple sclerosis

Comorbidity increases the risk of hospitalizations in multiple sclerosis

Intensive care unit admission in multiple sclerosis

The development of a method for comparative costing of individual intensive care units

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