A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project.
A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project.
复制标题
ICU 幸存者护理的新方法：人口健康质量改善项目。
作者：
Kenneth P. Snell;Cynthia L. Beiter;Erin L. Hall;Anthony S. Junod;Bradley J. Wilson;Daniel K. Lepone;Jeremy R. McIntyre;Danielle Phelps Swartz;Andrea L. Berger;H. Lester Kirchner;Janet F. Tomcavage;K. Korzick
目标
为ICU幸存者护理及其主要家庭照顾者提供一种新的跨学科护理过程，并评估与常规护理相比的死亡率，再入院率和经济影响。
设计
人口健康质量改善的回顾性资料分析。
设置
一家三级农村医院，设有内科/外科、神经科学、创伤和心脏ICU。
患者
ICU幸存者。
干预措施
重组现有的出院后医疗保健服务资源，以形成ICU幸存者诊所护理流程，并将此新流程与出院后常规护理流程进行比较。
测量值和主要结果
从电子健康记录中提取人口统计学数据、急性生理学和慢性健康评估IV评分和Charlson Comorbid指数评分。从护理经理数据库中提取其他数据。经济数据从Geisinger健康计划数据库中提取，并由健康经济学家进行分析。在分析的13个月期间，与常规治疗相比，ICU幸存者治疗患者的死亡率降低，这通过Kaplan-Meier方法（ICU幸存者治疗0.89 vs常规治疗0.71;对数秩p = 0.0108）和风险调整的稳定治疗加权逆概率（风险比，0.157; 95% CI，0.058-0.427）确定。再次入院接受ICU幸存者护理与常规护理：30天时（10.4% vs 26.3%;治疗加权风险比的稳定逆概率，0.539; 95% CI，0.224-1.297）和60天时（16.7% vs 34.7%;治疗加权风险比的稳定逆概率，0.525; 95% CI，0.240-1.145）。财务数据分析表明，在所分析的时间段内，Geisinger健康计划的估计年度成本节省范围为247，052美元至424，846美元。
结论
与通常的护理流程相比，我们的ICU幸存者护理流程降低了死亡率，并为保险公司节省了年度净成本。再入院率无统计学显著差异。
OBJECTIVES
Deliver a novel interdisciplinary care process for ICU survivor care and their primary family caregivers, and assess mortality, readmission rates, and economic impact compared with usual care.
DESIGN
Population health quality improvement comparative study with retrospective data analysis.
SETTING
A single tertiary care rural hospital with medical/surgical, neuroscience, trauma, and cardiac ICUs.
PATIENTS
ICU survivors.
INTERVENTIONS
Reorganization of existing post discharge health care delivery resources to form an ICU survivor clinic care process and compare this new process to post discharge usual care process.
MEASUREMENTS AND MAIN RESULTS
Demographic data, Acute Physiology and Chronic Health Evaluation IV scores, and Charlson Comorbidity Index scores were extracted from the electronic health record. Additional data was extracted from the care manager database. Economic data were extracted from the Geisinger Health Plan database and analyzed by a health economist. During 13-month period analyzed, patients in the ICU survivor care had reduced mortality compared with usual care, as determined by the Kaplan-Meier method (ICU survivor care 0.89 vs usual care 0.71; log-rank p = 0.0108) and risk-adjusted stabilized inverse probability of treatment weighting (hazard ratio, 0.157; 95% CI, 0.058-0.427). Readmission for ICU survivor care versus usual care: at 30 days (10.4% vs 26.3%; stabilized inverse probability of treatment weighting hazard ratio, 0.539; 95% CI, 0.224-1.297) and at 60 days (16.7% vs 34.7%; stabilized inverse probability of treatment weighting hazard ratio, 0.525; 95% CI, 0.240-1.145). Financial data analysis indicates estimated annual cost savings to Geisinger Health Plan ranges from $247,052 to $424,846 during the time period analyzed.
CONCLUSIONS
Our ICU survivor care process results in decreased mortality and a net annual cost savings to the insurer compared with usual care processes. There was no statistically significant difference in readmission rates.
登录
查看更多内容
影响因子：
76.2
作者：
Jackson, James C.;Pandharipande, Pratik P.;Girard, Timothy D.;Brummel, Nathan E.;Thompson, Jennifer L.;Hughes, Christopher G.;Pun, Brenda T.;Vasilevskis, Eduard E.;Morandi, Alessandro;Shintani, Ayumi K.;Hopkins, Ramona O.;Bernard, Gordon R.;Dittus, Robert S.;Ely, E. Wesley
通讯作者：
Ely, E. Wesley
DOI：
10.1164/rccm.201111-2025oc
发表时间：
2012-06-15
影响因子：
24.7
作者：
Mikkelsen, Mark E.;Christie, Jason D.;Angus, Derek C.
通讯作者：
Angus, Derek C.
慢性危重患者：疾病管理干预后与健康相关的生活质量和资源利用。
DOI：
--
发表时间：
2007
期刊：
American journal of critical care : an official publication, American Association of Critical-Care Nurses
影响因子：
--
作者：
Douglas,SaraL;Daly,BarbaraJ;Kelley,CarolGenet;O'Toole,Elizabeth;Montenegro,Hugo
通讯作者：
Montenegro,Hugo
DOI：
10.1001/jama.2010.1553
发表时间：
2010-10-27
期刊：
JAMA
影响因子：
--
作者：
Iwashyna TJ;Ely EW;Smith DM;Langa KM
通讯作者：
Langa KM