Advance Identification of Patients With Chronic Conditions and Acute Respiratory Failure at Greatest Risk for High-Intensity, Costly Care

Patients with underlying chronic illness requiring mechanical ventilation for acute respiratory failure are at risk for poor outcomes and high costs. Identify characteristics at time of intensive care unit (ICU) admission that identify patients at highest risk for high-intensity, costly care. Retros...

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Veröffentlicht in:Journal of pain and symptom management Jg. 63; H. 4; S. 618 - 626
Hauptverfasser: Khandelwal, Nita, May, Peter, Downey, Lois M., Engelberg, Ruth A., Curtis, J. Randall
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.04.2022
Elsevier Limited
Schlagworte:
acute respiratory failure
Aged
Anesthesia
chronic conditions
Chronic Disease
Chronic illnesses
Cohort analysis
Costs
Critical care
Dementia
Health care expenditures
Health care industry
Health services
high intensity care
Hospitalization
Hospitals
Humans
Indexes
Intensive care
Intensive Care Units
Kidney diseases
Mechanical ventilation
Pain Medicine
Palliative care
Patients
Respiration, Artificial
Respiratory Distress Syndrome - therapy
Respiratory failure
Respiratory Insufficiency - therapy
Retrospective Studies
Risk
Ventilation
Ventilators
Weight loss
Critical care
acute respiratory failure
high intensity care
chronic conditions
ISSN:0885-3924, 1873-6513, 1873-6513
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Zusammenfassung:Patients with underlying chronic illness requiring mechanical ventilation for acute respiratory failure are at risk for poor outcomes and high costs. Identify characteristics at time of intensive care unit (ICU) admission that identify patients at highest risk for high-intensity, costly care. Retrospective cohort study using electronic health and financial records (2011-2017) for patients requiring ≥48 hours of mechanical ventilation with ≥1 underlying chronic condition at an academic healthcare system. Main outcome was total cost of index hospitalization. Exposures of interest included number and type of chronic conditions. We used finite mixture models to identify the highest-cost group. 4,892 patients met study criteria. Median cost for index hospitalization was $135,238 (range, $9,748 –$3,176,065). Finite mixture modelling identified three classes with mean costs of $89,980, $150,603, and $277,712. Patients more likely to be in the high-cost class were: 1) < 72 years old (OR: 2.03; 95% CI:1.63, 2.52); 2) with dementia (OR: 1.55; 95% CI:1.17, 2.06) or chronic renal failure (OR: 1.27; 95% CI:1.08, 1.48); 3) weight loss ≥ 5% in year prior to hospital admission (OR: 1.25; 95% CI:1.05, 1.48); and 4) hospitalized during prior year (OR: 1.92; 95% CI:1.58, 2.35). Among patients with underlying chronic illness and acute respiratory failure, we identified characteristics associated with the highest costs of care. Identifying these patients may be of interest to healthcare systems and hospitals and serve as one indication to invest resources in palliative and supportive care programs that ensure this care is consistent with patients’ goals.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0885-3924
1873-6513
1873-6513
DOI:10.1016/j.jpainsymman.2021.11.004