期刊
INTENSIVE CARE MEDICINE
卷 43, 期 7, 页码 980-991出版社
SPRINGER
DOI: 10.1007/s00134-017-4827-8
关键词
Patient readmission; Healthcare; Cost; Quality of life; Critical illness
资金
- National Heart, Lung, and Blood Institute [N01HR56170, R01HL091760, 3R01HL091760-02S1]
- ARDS Network [HHSN268200536165C, HHSN268200536166C, HHSN268200536167C, HHSN268200536168C, HHSN268200536169C, HHSN268200536170C, HHSN268200536171C, HHSN268200536172C, HHSN268200536173C, HHSN268200536174C, HHSN268200536175C, HHSN268200536176C, HHSN268200536179C]
Purpose: To evaluate (1) post-discharge healthcare utilization and estimated costs in ARDS survivors, and (2) the association between patient and intensive care-related variables, and 6-month patient status, with subsequent hospitalization and costs. Methods: Longitudinal cohort study enrolling from four ARDSNet trials in 44 US hospitals. Healthcare utilization was collected via structured interviews at 6 and 12 months post-ARDS, and hospital costs estimated via the Medical Expenditure Panel Survey. Adjusted odds ratios for hospitalization and adjusted relative medians for hospital costs were calculated using marginal two-part regression models. Results: Of 859 consenting survivors, 839 (98%) reported healthcare utilization, with 52% female and a mean age of 49 years old. Over 12 months, 339 (40%) patients reported at least one post-discharge hospitalization, with median estimated hospital costs of US$ 18,756 (interquartile range $7852-46,174; 90th percentile $ 101,500). Of 16 patient baseline and ICU variables evaluated, only cardiovascular comorbidity and length of stay were associated with hospitalization, and sepsis was associated with hospital costs. At 6-month assessment, better patient-reported physical activity and quality of life status were associated with fewer hospitalizations and lower hospital costs during subsequent follow-up, and worse psychiatric symptoms were associated with increased hospitalizations. Conclusions: This multicenter longitudinal study found that 40% of ARDS survivors reported at least one post-discharge hospitalization during 12-month follow-up. Few patient-or ICU-related variables were associated with hospitalization; however, physical, psychiatric, and quality of life measures at 6-month follow-up were associated with subsequent hospitalization. Interventions to reduce post-ARDS morbidity may be important to improve patient outcomes and reduce healthcare utilization.
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