Resource Utilization Among Intensive Care Patients

Rapoport, John; Gehlbach, Stephen H.; Lemeshow, Stanley; Teres, Daniel

doi:10.1001/archinte.1992.00400230033006

Cited by 92 publications

(3 citation statements)

References 9 publications

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“…Chronic kidney disease is <60 mL/min glomerular filtration rate calculated from the Modification of Diet in Renal Disease (MDRD) equation using pre-hospital or hospital admission creatinine as baseline [32]. Changes from the expected hospital length of stay (LOS) are determined by subtracting the actual LOS from the geometric mean LOS for each Diagnostic Related Grouping (DRG) a classification system for hospital cases [33]. The geometric mean LOS is the United States national mean LOS for each DRG per the Centers for Medicare & Medicaid Services [34].…”

Section: Methodsmentioning

confidence: 99%

Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study

Weijs

Mogensen

Rawn

et al. 2019

JCM

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Background: We hypothesized that protein delivery during hospitalization in patients who survived critical care would be associated with outcomes following hospital discharge. Methods: We studied 801 patients, age ≥ 18 years, who received critical care between 2004 and 2012 and survived hospitalization. All patients underwent a registered dietitian formal assessment within 48 h of ICU admission. The exposure of interest, grams of protein per kilogram body weight delivered per day, was determined from all oral, enteral and parenteral sources for up to 28 days. Adjusted odds ratios for all cause 90-day post-discharge mortality were estimated by mixed- effects logistic regression models. Results: The 90-day post-discharge mortality was 13.9%. The mean nutrition delivery days recorded was 15. In a mixed-effect logistic regression model adjusted for age, gender, race, Deyo-Charlson comorbidity index, acute organ failures, sepsis and percent energy needs met, the 90-day post-discharge mortality rate was 17% (95% CI: 6–26) lower for each 1 g/kg increase in daily protein delivery (OR = 0.83 (95% CI 0.74–0.94; p = 0.002)). Conclusions: Adult medical ICU patients with improvements in daily protein intake during hospitalization who survive hospitalization have decreased odds of mortality in the 3 months following hospital discharge.

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Section: Methodsmentioning

confidence: 99%

Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study

Weijs

Mogensen

Rawn

et al. 2019

JCM

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“…We utilized the Deyo–Charlson Index to assess the burden of chronic illness, which is well studied and validated [23]. Patient type was defined as medical or surgical and incorporates the DRG methodology devised by Centers for Medicare & Medicaid Services [24]. We employed the validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding algorithms developed by Quan et al [25] to derive a Deyo–Charlson Index comorbidity score for each patient [26].…”

Section: Methodsmentioning

confidence: 99%

Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study

Purtle

Horkan

Moromizato³

et al. 2017

Crit Care

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BackgroundLittle is known about risk factors associated with out-of-hospital outcomes in survivors of critical illness. We hypothesized that the presence of nucleated red blood cells in patients who survived critical care would be associated with adverse outcomes following hospital discharge.MethodsWe performed a two-center observational cohort study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. All data were obtained from the Research Patient Data Registry at Partners HealthCare. We studied 2878 patients, age ≥ 18 years, who received critical care between 2011 and 2015 and survived hospitalization. The exposure of interest was nucleated red blood cells occurring from 2 days prior to 7 days after critical care initiation. The primary outcome was mortality in the 90 days following hospital discharge. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both nucleated red blood cells and outcome. Adjustment included age, race (white versus nonwhite), gender, Deyo–Charlson Index, patient type (medical versus surgical), sepsis and acute organ failure.ResultsIn patients who received critical care and survived hospitalization, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8% and 21.9% in patients with 0/μl, 1–100/μl, 101–200/μl and more than 200/μl nucleated red blood cells respectively. Nucleated red blood cells were a robust predictor of postdischarge mortality and remained so following multivariable adjustment. The fully adjusted odds of 90-day postdischarge mortality in patients with 1–100/μl, 101–200/μl and more than 200/μl nucleated red blood cells were 1.77 (95% CI, 1.23–2.54), 2.51 (95% CI, 1.36–4.62) and 3.72 (95% CI, 2.16–6.39) respectively, relative to patients without nucleated red blood cells. Further, the presence of nucleated red blood cells is a significant predictor of the odds of unplanned 30-day hospital readmission.ConclusionIn critically ill patients who survive hospitalization, the presence of nucleated red blood cells is a robust predictor of postdischarge mortality and unplanned hospital readmission.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1724-z) contains supplementary material, which is available to authorized users.

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“…Charge data 10,11 are determined from the hospital charges that appear on patient bills. These data are easily obtained; however, because charges are designed to maximize reimbursement, they do not accurately reflect resource utilization.…”

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confidence: 99%

Predictors of Acute Hospital Costs for Treatment of Ischemic Stroke in an Academic Center

Diringer

Edwards

Mattson

et al. 1999

Stroke

190

144

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Background and Purpose-We sought to determine predictors of acute hospital costs in patients presenting with acute ischemic stroke to an academic center using a stroke management team to coordinate care. Methods-Demographic and clinical data were prospectively collected on 191 patients consecutively admitted with acute ischemic stroke. Patients were classified by insurance status, premorbid modified Rankin scale, stroke location, stroke severity (National Institutes of Health Stroke Scale score), and presence of comorbidities. Detailed hospital charge data were converted to cost by application of department-specific cost-to-charge ratios. Physician's fees were not included.A stepwise multiple regression analysis was computed to determine the predictors of total hospital cost. Results-Median length of stay was 6 days (range, 1 to 63 days), and mortality was 3%. Median hospital cost per discharge was $4408 (range, $1199 to $59 799). Fifty percent of costs were for room charges, 19% for stroke evaluation, 21% for medical management, and 7% for acute rehabilitation therapies. Sixteen percent were admitted to an intensive care unit. Length of stay accounted for 43% of the variance in total cost. Other independent predictors of cost included stroke severity, heparin treatment, atrial fibrillation, male sex, ischemic cardiac disease, and premorbid functional status. Conclusions-We conclude that the major predictors of acute hospital costs of stroke in this environment are length of stay, stroke severity, cardiac disease, male sex, and use of heparin. Room charges accounted for the majority of costs, and attempts to reduce the cost of stroke evaluation would be of marginal value. Efforts to reduce acute costs should be monitored for potential cost shifting or a negative impact on quality of care. (Stroke. 1999;30:724-728.)

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Resource Utilization Among Intensive Care Patients

Abstract: Even in a setting where there would appear to be relatively little room for discretion in treatment decisions, incentives associated with type of health insurance seemed to affect resource use.

Cited by 92 publications

References 9 publications

Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study

Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study

Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study

Predictors of Acute Hospital Costs for Treatment of Ischemic Stroke in an Academic Center

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