Health Care Resource Use and Costs of Two-Year Survivors of Acute Lung Injury. An Observational Cohort Study

Ruhl, A. Parker; Lord, Robert K.; Panek, Julia A.; Colantuoni, Elizabeth; Sepúlveda, Kristin A.; Chong, Alexandra; Dinglas, Victor D.; Shanholtz, Carl; Pronovost, Peter J.; Steinwachs, Donald M.; Needham, Dale M.

doi:10.1513/annalsats.201409-422oc

Cited by 39 publications

(37 citation statements)

References 64 publications

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“…Comparison with other studies reporting health care resource use or costs is difficult because of organizational differences at ICU and wider health service level and international differences in costing health care (35). However, compared with resource data for the first year after discharge summarized in a systematic review and a more recent publication (35,36), our cohort experienced comparable hospital readmission rates (1.1 compared with 0.6-2.8/patient) and days in hospital Some studies with control populations report results in conflict with our findings. A Canadian study reported that ICU survivors had a lower readmission rate compared with hospital control subjects during 3 years of follow-up (ARR, 0.80; 95% CI, 0.77-0.82) (37).…”

Section: Discussionmentioning

confidence: 99%

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Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Lone

Gillies

Haddow

et al. 2016

Am J Respir Crit Care Med

189

155

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Rationale: Survivors of critical illness experience significant morbidity, but the impact of surviving the intensive care unit (ICU) has not been quantified comprehensively at a population level.Objectives: To identify factors associated with increased hospital resource use and to ascertain whether ICU admission was associated with increased mortality and resource use.Methods: Matched cohort study and pre/post-analysis using national linked data registries with complete population coverage. The population consisted of patients admitted to all adult general ICUs during 2005 and surviving to hospital discharge, identified from the Scottish Intensive Care Society Audit Group registry, matched (1:1) with similar hospital control subjects. Five-year outcomes included mortality and hospital resource use. Confounder adjustment was based on multivariable regression and pre/post within-individual analyses.Measurements and Main Results: Of 7,656 ICU patients, 5,259 survived to hospital discharge (5,215 [99.2%] matched to hospital control subjects). Factors present before ICU admission (comorbidities/pre-ICU hospitalizations) were stronger predictors of hospital resource use than acute illness factors. In the 5 years after the initial hospital discharge, compared with hospital control subjects, the ICU cohort had higher mortality (32.3% vs. 22.7%; hazard ratio, 1.33; 95% confidence interval, 1.22-1.46; P , 0.001), used more hospital resources (mean hospital admission rate, 4.8 vs. 3.3/person/5 yr), and had 51% higher mean 5-year hospital costs ($25,608 vs. $16,913/patient). Increased resource use persisted after confounder adjustment (P , 0.001) and using pre/post-analyses (P , 0.001). Excess resource use and mortality were greatest for younger patients without significant comorbidity.Conclusions: This complete, national study demonstrates that ICU survivorship is associated with higher 5-year mortality and hospital resource use than hospital control subjects, representing a substantial burden on individuals, caregivers, and society.

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Section: Discussionmentioning

confidence: 99%

“…Although hospital resource use dominates postdischarge costs (35,36), extending resource measurement beyond this to social care and societal costs, such as loss of earnings or the financial burden on caregivers, would have allowed a more comprehensive assessment of resource use (42).…”

Section: Discussionmentioning

confidence: 99%

Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Lone

Gillies

Haddow

et al. 2016

Am J Respir Crit Care Med

189

155

View full text Add to dashboard Cite

show abstract

“…These differences likely reflect distinct stakeholders’ perspectives. After hospital discharge, ARF survivors experience high rates of hospital readmission and unemployment(2, 44) creating a direct financial burden for patients and caregivers. Similarly, clinical researchers were likely aware of mortality as a competing risk in evaluating functional outcomes (45, 46) and thus, universally viewed survival as essential whereas all caregivers on the panel had family members who were still alive years after ARF.…”

Section: Discussionmentioning

confidence: 99%

Core Domains for Clinical Research in Acute Respiratory Failure Survivors: An International Modified Delphi Consensus Study

Turnbull¹,

Sepúlveda

Dinglas

et al. 2017

Critical Care Medicine

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Objectives To identify the core “domains” (i.e., patient outcomes, health-related conditions, or aspects of health) that relevant stakeholders agree are essential to assess in all clinical research studies evaluating the outcomes of acute respiratory failure survivors after hospital discharge. Design A two-round consensus process, using a modified Delphi methodology, with participants from 16 countries, including patient and caregiver representatives. Prior to voting, participants were asked to review: 1) results from surveys of clinical researchers, acute respiratory failure survivors, and caregivers, that rated the importance of 19 preliminary outcome domains, and 2) results from a qualitative study of acute respiratory failure survivors’ outcomes after hospital discharge, as related to the 19 preliminary outcome domains. Participants also were asked to suggest any additional potential domains for evaluation in the first Delphi survey. Setting Web-based surveys of participants representing 4 stakeholder groups relevant to clinical research evaluating post-discharge outcomes of acute respiratory failure survivors: clinical researchers, clinicians, patients and caregivers, and US federal research funding organizations. Interventions None. Measurements and Main Results Survey response rates were 97% and 99% in Round 1 and Round 2 respectively. There were 7 domains that met the a priori consensus criteria to be designated as core domains: physical function, cognition, mental health, survival, pulmonary function, pain, and muscle and/or nerve function. Conclusion This study generated a consensus-based list of core domains that should be assessed in all clinical research studies evaluating acute respiratory failure survivors after hospital discharge. Identifying appropriate measurement instruments to assess these core domains is an important next step toward developing a set of core outcome measures for this field of research.

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“…In addition, hospital readmission before recovery of dysphagia symptoms (on the basis of patient self-report with medical records verification [30]) was evaluated as a binary variable.…”

Section: Measurement Of Patient- Icu- and Hospital-related Exposurementioning

confidence: 99%

Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study

Brodsky¹,

et al. 2017

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Rationale: Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital.Objectives: To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation.Methods: This is a prospective, 5-year longitudinal cohort study involving 13 ICUs at four teaching hospitals in Baltimore, Maryland. The Sydney Swallowing Questionnaire (SSQ), a 17-item visual analog scale (range, 0-1,700), was used to quantify patient-perceived dysphagia symptoms at hospital discharge, and at 3, 6, 12, 24, 36, 48, and 60 months after ARDS. An SSQ score greater than or equal to 200 was used to indicate clinically important dysphagia symptoms at the time of hospital discharge. Recovery was defined as an SSQ score less than 200, with a decrease from hospital discharge greater than or equal to 119, the reliable change index for SSQ score. Fine and Gray proportional subdistribution hazards regression analysis was used to evaluate patient and ICU variables associated with time to recovery accounting for the competing risk of death.Measurements and Main Results: Thirty-seven (32%) of 115 patients had an SSQ score greater than or equal to 200 at hospital discharge; 3 died before recovery. All 34 remaining survivors recovered from dysphagia symptoms by 5-year follow-up, 7 (23%) after 6 months. ICU length of stay was independently associated with time to recovery, with a hazard ratio (95% confidence interval) of 0.96 (0.93-1.00) per day. Conclusions:One-third of orally intubated ARDS survivors have dysphagia symptoms that persist beyond hospital discharge. Patients with a longer ICU length of stay have slower recovery from dysphagia symptoms and should be carefully considered for swallowing assessment to help prevent complications related to dysphagia.

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Health Care Resource Use and Costs of Two-Year Survivors of Acute Lung Injury. An Observational Cohort Study

Cited by 39 publications

References 64 publications

Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Core Domains for Clinical Research in Acute Respiratory Failure Survivors: An International Modified Delphi Consensus Study

Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study

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