TY - JOUR
T1 - Healthcare resource use and costs in long-term survivors of acute respiratory distress syndrome
T2 - A 5-year longitudinal cohort study
AU - Ruhl, A. Parker
AU - Huang, Minxuan
AU - Colantuoni, Elizabeth
AU - Lord, Robert K.
AU - Dinglas, Victor D.
AU - Chong, Alexandra
AU - Sepulveda, Kristin A.
AU - Mendez-Tellez, Pedro A.
AU - Shanholtz, Carl B.
AU - Steinwachs, Donald M.
AU - Pronovost, Peter J.
AU - Needham, Dale M.
N1 - Publisher Copyright:
© 2017 Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Objective: To evaluate the time-varying relationship of annual physical, psychiatric, and quality of life status with subsequent inpatient healthcare resource use and estimated costs. Design: Five-year longitudinal cohort study. Setting: Thirteen ICUs at four teaching hospitals. Patients: One hundred thirty-eight patients surviving greater than or equal to 2 years after acute respiratory distress syndrome. Interventions: None. Measurements and Main Results: Postdischarge inpatient resource use data (e.g., hospitalizations, skilled nursing, and rehabilitation facility stays) were collected via a retrospective structured interview at 2 years, with prospective collection every 4 months thereafter, until 5 years postacute respiratory distress syndrome. Adjusted odds ratios for hospitalization and relative medians for estimated episode of care costs were calculated using marginal longitudinal two-part regression. The median (interquartile range) number of inpatient admission hospitalizations was 4 (2-8), with 114 patients (83%) reporting greater than or equal to one hospital readmission. The median (interquartile range) estimated total inpatient postdischarge costs over 5 years were $58,500 ($19,700-157,800; 90th percentile, $328,083). Better annual physical and quality of life status, but not psychiatric status, were associated with fewer subsequent hospitalizations and lower follow-up costs. For example, greater grip strength (per 6 kg) had an odds ratio (95% CI) of 0.85 (0.73-1.00) for inpatient admission, with 23% lower relative median costs, 0.77 (0.69-0.87). Conclusions: In a multisite cohort of long-term acute respiratory distress syndrome survivors, better annual physical and quality of life status, but not psychiatric status, were associated with fewer hospitalizations and lower healthcare costs.
AB - Objective: To evaluate the time-varying relationship of annual physical, psychiatric, and quality of life status with subsequent inpatient healthcare resource use and estimated costs. Design: Five-year longitudinal cohort study. Setting: Thirteen ICUs at four teaching hospitals. Patients: One hundred thirty-eight patients surviving greater than or equal to 2 years after acute respiratory distress syndrome. Interventions: None. Measurements and Main Results: Postdischarge inpatient resource use data (e.g., hospitalizations, skilled nursing, and rehabilitation facility stays) were collected via a retrospective structured interview at 2 years, with prospective collection every 4 months thereafter, until 5 years postacute respiratory distress syndrome. Adjusted odds ratios for hospitalization and relative medians for estimated episode of care costs were calculated using marginal longitudinal two-part regression. The median (interquartile range) number of inpatient admission hospitalizations was 4 (2-8), with 114 patients (83%) reporting greater than or equal to one hospital readmission. The median (interquartile range) estimated total inpatient postdischarge costs over 5 years were $58,500 ($19,700-157,800; 90th percentile, $328,083). Better annual physical and quality of life status, but not psychiatric status, were associated with fewer subsequent hospitalizations and lower follow-up costs. For example, greater grip strength (per 6 kg) had an odds ratio (95% CI) of 0.85 (0.73-1.00) for inpatient admission, with 23% lower relative median costs, 0.77 (0.69-0.87). Conclusions: In a multisite cohort of long-term acute respiratory distress syndrome survivors, better annual physical and quality of life status, but not psychiatric status, were associated with fewer hospitalizations and lower healthcare costs.
KW - critical illness
KW - health care costs
KW - intensive care unit
KW - patient readmission
KW - respiratory distress syndrome, acute
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U2 - 10.1097/CCM.0000000000002088
DO - 10.1097/CCM.0000000000002088
M3 - Article
C2 - 27748659
AN - SCOPUS:84991457468
SN - 0090-3493
VL - 45
SP - 196
EP - 204
JO - Critical care medicine
JF - Critical care medicine
IS - 2
ER -