Population Trends in Intensive Care Unit Admissions in the United States Among Medicare Beneficiaries, 2006–2015

Weissman, Gary E.; Kerlin, Meeta Prasad; Yuan, Yihao; Gabler, Nicole B.; Groeneveld, Peter W.; Werner, Rachel M.; Halpern, Scott D.

doi:10.7326/m18-1425

Cited by 23 publications

(19 citation statements)

References 5 publications

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“…Intensive care has grown substantially over the past decades worldwide [1][2][3] to be one of the most resourceintensive acute hospital services [4]. Heavy utilization of the intensive care unit (ICU) over the disease course contributes to high costs of health care [1] and raises concern over optimal use of ICU resources [5], especially for endof-life (EOL) care, which has increased in the last decade [6]. Landmark studies highlighted the improving but still poor quality of EOL care in ICUs [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Course and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavement

Tang

Huang

et al. 2021

Crit Care

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Background/Objective Death in intensive care units (ICUs) may increase bereaved family members’ risk for posttraumatic stress disorder (PTSD). However, posttraumatic stress-related symptoms (hereafter as PTSD symptoms) and their precipitating factors were seldom examined among bereaved family members and primarily focused on associations between PTSD symptoms and patient/family characteristics. We aimed to investigate the course and predictors of clinically significant PTSD symptoms among family members of deceased ICU patients by focusing on modifiable quality indicators for end-of-life ICU care. Method In this longitudinal observational study, 319 family members of deceased ICU patients were consecutively recruited from medical ICUs from two Taiwanese medical centers. PTSD symptoms were assessed at 1, 3, 6, and 13 months post-loss using the Impact of Event Scale-Revised (IES-R). Family satisfaction with end-of-life care in ICUs was assessed at 1 month post-loss. End-of-life care received in ICUs was documented over the patient’s ICU stay. Predictors for developing clinically significant PTSD symptoms (IES-R score ≥ 33) were identified by multivariate logistic regression with generalized estimating equation modeling. Results The prevalence of clinically significant PTSD symptoms decreased significantly over time (from 11.0% at 1 month to 1.6% at 13 months post-loss). Longer ICU stays (adjusted odds ratio [95% confidence interval] = 1.036 [1.006, 1.066]), financial insufficiency (3.166 [1.159, 8.647]), and reported use of pain medications (3.408 [1.230, 9.441]) by family members were associated with a higher likelihood of clinically significant PTSD symptoms among family members during bereavement. Stronger perceived social support (0.937 [0.911, 0.965]) and having a Do-Not-Resuscitate (DNR) order issued before the patient’s death (0.073 [0.011, 0.490]) were associated with a lower likelihood of clinically significant PTSD symptoms. No significant association was observed for family members’ satisfaction with end-of-life care (0.988 [0.944, 1.034]) or decision-making in ICUs (0.980 [0.944, 1.018]). Conclusions The likelihood of clinically significant PTSD symptoms among family members decreased significantly over the first bereavement year and was lower when a DNR order was issued before death. Enhancing social support and facilitating a DNR order may reduce the trauma of ICU death of a beloved for family members at risk for developing clinically significant PTSD symptoms.

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Section: Introductionmentioning

confidence: 99%

Course and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavement

Tang

Huang

et al. 2021

Crit Care

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“…30 To the extent that such an approach achieves better alignment of patient preferences and treatment received, hospitals and health systems could realize both cost savings and higher quality end-of-life care. 31 The inconsistency of demand elasticity in our results is important in light of recent observational data suggesting that increased ICU utilization may confer a clinical benefit in certain patient populations but not in others, 9,21,32 If demand elasticity operated consistently across patient populations, then constraining the growth of the ICU supply could create a tradeoff involving overall reductions in inefficient ICU admissions along with some reduction in potentially beneficial ICU admissions. However, inconsistent demand elasticity could create mismatched changes in utilization that lead to continued inefficient admissions and reductions in beneficial admissions, or vice versa-making it difficult to predict the impact of supply constraints on overall cost growth and patient outcomes.…”

Section: Discussionmentioning

confidence: 86%

“…18 However, at the system level, there is conflicting evidence for supplydriven ICU admissions, with some studies supporting demand elasticity in neonates and elderly patients with advanced dementia, at least one study showing no association between supply and utilization for Medicare. [19][20][21] In concert, these studies suggest that increased availability of ICU beds may drive inefficient use of ICU resources at a local level, although the reproducibility of this finding at the health system level remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Effects of Changes in ICU Bed Supply on ICU Utilization

2019

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“…In 2015, 13 million Americans were admitted to intensive care units (ICUs) with almost 15% of those dying following admission. 1,2 Good communication between families and clinicians is the most important factor for high quality of end-of-life (EOL) care in the ICU 3,4 because patients with lifethreatening illness are not able to talk, and families often act as surrogates on patients' behalf to make EOL decisions and advocate for quality care. 5 In general, communication is "the mutual creation of meaning by both communicators."…”

Section: Introductionmentioning

confidence: 99%

Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units

Chen

Meier

2019

Am J Hosp Palliat Care

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Background: Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments’ psychometric properties and determine which best measures family–clinician communication in the ICU. Method: A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties. Instruments: Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician–Family Caregiver Communication, and Quality of Communication (QOC). Results: Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC’s convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families’ treatment response in randomized control trials. Conclusion: Quality of Communication is the most suitable instrument to measure family’s perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family–clinician communication and data about how to improve EOL care in ICUs.

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Population Trends in Intensive Care Unit Admissions in the United States Among Medicare Beneficiaries, 2006–2015

Cited by 23 publications

References 5 publications

Course and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavement

Course and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavement

Effects of Changes in ICU Bed Supply on ICU Utilization

Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units

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