| One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. | |
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MedLine Citation:
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PMID: 20679561 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Growing numbers of critically ill patients receive prolonged mechanical ventilation. Little is known about the patterns of care as patients transition from acute care hospitals to postacute care facilities or about the associated resource utilization. OBJECTIVE: To describe 1-year trajectories of care and resource utilization for patients receiving prolonged mechanical ventilation. DESIGN: 1-year prospective cohort study. SETTING: 5 intensive care units at Duke University Medical Center, Durham, North Carolina. PARTICIPANTS: 126 patients receiving prolonged mechanical ventilation (defined as ventilation for >or=4 days with tracheostomy placement or ventilation for >or=21 days without tracheostomy), as well as their 126 surrogates and 54 intensive care unit physicians, enrolled consecutively over 1 year. MEASUREMENTS: Patients and surrogates were interviewed in the hospital, as well as 3 and 12 months after discharge, to determine patient survival, functional status, and facility type and duration of postdischarge care. Physicians were interviewed in the hospital to elicit prognoses. Institutional billing records were used to assign costs for acute care, outpatient care, and interfacility transportation. Medicare claims data were used to assign costs for postacute care. RESULTS: 103 (82%) hospital survivors had 457 separate transitions in postdischarge care location (median, 4 transitions [interquartile range, 3 to 5 transitions]), including 68 patients (67%) who were readmitted at least once. Patients spent an average of 74% (95% CI, 68% to 80%) of all days alive in a hospital or postacute care facility or receiving home health care. At 1 year, 11 patients (9%) had a good outcome (alive with no functional dependency), 33 (26%) had a fair outcome (alive with moderate dependency), and 82 (65%) had a poor outcome (either alive with complete functional dependency [4 patients; 21%] or dead [56 patients; 44%]). Patients with poor outcomes were older, had more comorbid conditions, and were more frequently discharged to a postacute care facility than patients with either fair or good outcomes (P < 0.05 for all). The mean cost per patient was $306,135 (SD, $285,467), and total cohort cost was $38.1 million, for an estimated $3.5 million per independently functioning survivor at 1 year. LIMITATION: The results of this single-center study may not be applicable to other centers. CONCLUSION: Patients receiving prolonged mechanical ventilation have multiple transitions of care, resulting in substantial health care costs and persistent, profound disability. The optimism of surrogate decision makers should be balanced by discussions of these outcomes when considering a course of prolonged life support. PRIMARY FUNDING SOURCE: None. |
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Authors:
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Mark Unroe; Jeremy M Kahn; Shannon S Carson; Joseph A Govert; Tereza Martinu; Shailaja J Sathy; Alison S Clay; Jessica Chia; Alice Gray; James A Tulsky; Christopher E Cox |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Annals of internal medicine Volume: 153 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-03 Completed Date: 2010-08-13 Revised Date: 2011-08-01 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 167-75 Citation Subset: AIM; IM |
Affiliation:
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Duke University, Durham, North Carolina 27710, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Critical Illness / economics*, mortality, therapy* Female Health Care Costs Health Resources / economics, utilization* Humans Intensive Care Units / economics Length of Stay / economics Male Middle Aged North Carolina Outcome Assessment (Health Care)* Patient Discharge / economics Patient Transfer / economics Prospective Studies Quality of Life Respiration, Artificial / economics* Survival Analysis Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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K23 HL067068/HL/NHLBI NIH HHS; K23 HL081048/HL/NHLBI NIH HHS; K23 HL081048-01/HL/NHLBI NIH HHS; K23 HL081048-02/HL/NHLBI NIH HHS; K23 HL081048-03/HL/NHLBI NIH HHS; K23 HL081048-04/HL/NHLBI NIH HHS; K23 HL081048-05/HL/NHLBI NIH HHS; K23 HL082650/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Ann Intern Med. 2010 Aug 3;153(3):I56
[PMID:
20679556
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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