Impact of Critical Illness on Resource Utilization: A Comparison of Use in the Year Before and After ICU Admission*
Open Access
- 1 November 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 47 (11), 1497-1504
- https://doi.org/10.1097/ccm.0000000000003970
Abstract
Increasingly, patients admitted to an ICU survive to hospital discharge; many with ongoing medical needs. The full impact of an ICU admission on an individual’s resource utilization and survivorship trajectory in the United States is not clear. We sought to compare healthcare utilization among ICU survivors in each year surrounding an ICU admission. Retrospective cohort of patients admitted to an ICU during one calendar year (2012) in a multipayer healthcare system. We assessed mortality, hospital readmissions (categorized by ambulatory care sensitive conditions and emergency department), and outpatient visits. We compared the proportion of patients with visits during the pre-ICU year versus the post-ICU year. People admitted to an Intermountain healthcare ICU for greater than 48 hours in the year 2012 None. Among 4,074 ICU survivors, 45% had increased resource utilization. Readmission rates at 30-day, 90-day, and 1-year were 15%, 26%, and 43%. The proportion of patients with a hospital admission increased significantly in the post-ICU period (43% vs 29%; p < 0.001). Of patients with a readmission in the post-ICU period, 24% were ambulatory care sensitive condition. Patients with increased utilization differed by socioeconomic status, insurance type, and severity of illness. Sixteen percent of patients had either an emergency department or inpatient admission, but no outpatient visits during the post-ICU period. An ICU admission is associated with increased resource utilization including hospital readmissions, with many due to an ambulatory care sensitive condition. Lower socioeconomic status and higher severity of illness are associated with increased resource utilization. After an ICU visit patients seem to use hospital resources over outpatient resources. Interventions to improve and coordinate care after ICU discharge are needed.This publication has 53 references indexed in Scilit:
- An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up studyCritical Care, 2013
- Weighing the Costs and Benefits of a SedativeJAMA, 2012
- Functional Disability 5 Years after Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2011
- Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational studyCritical Care, 2011
- Three-Year Outcomes for Medicare Beneficiaries Who Survive Intensive CareJAMA, 2010
- The puzzle of long-term morbidity after critical illnessCritical Care, 2010
- Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problemCritical Care, 2007
- Quality of Life of Individuals With Heart FailureMedical Care, 2002
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987