Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems.
Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems.
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DOI：
10.1097/cce.0000000000000658
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发表时间：
2022-03
影响因子：
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通讯作者：
Montgomery AA
中科院分区：
文献类型：
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作者：
Danesh V;Boehm LM;Eaton TL;Arroliga AC;Mayer KP;Kesler SR;Bakhru RN;Baram M;Bellinghausen AL;Biehl M;Dangayach NS;Goldstein NM;Hoehn KS;Islam M;Jagpal S;Johnson AB;Jolley SE;Kloos JA;Mahoney EJ;Maley JH;Martin SF;McSparron JI;Mery M;Saft H;Santhosh L;Schwab K;Villalba D;Sevin CM;Montgomery AA
危重病和新冠肺炎造成的多方面长期损害需要在疾病恢复阶段采取跨学科的管理方法。需要对来自不同卫生系统的康复诊所(RC)的结构和流程进行业务洞察。这项研究描述了美国大型卫生系统中现有的和新实施的ICU-RCS和COVID-RCS的结构和过程特征。横断面调查。29个卫生系统的总共156家医院的39个注册控制中心参加了会议。没有。没有。收集了RC的人口学数据、转诊标准和操作特征，包括用于评估身体、心理和认知康复的方法。完成了39项资源中心调查(回复率为94%)。ICU-RC团队包括医生、药剂师、社会工作者、物理治疗师和高级实践提供者。ICU-RCS的资金来源包括临床收费(n=20，77%)、志愿人员支持(n=15，58%)、机构工作人员/空间支持(n=13，46%)和赠款或基金会资助(n=3，12%)。46%的RCS报告患者就诊时间为1小时或更长时间。ICU-RC团队报告说，与COVID-RC团队(心理，54%；身体，69%；认知，46%)相比，在标准访问中，使用经过验证的量表来评估心理恢复(93%)、身体恢复(89%)和认知恢复(86%)的频率更高。驻地协调员的业务结构各不相同，尽管几乎所有机构都描述了有限的能力和对志愿服务和可自由支配的机构支助的依赖。美国的ICU-和COVID-RCS使用不同的资金来源，并在访问期间支持不同的评估措施，以指导护理协调。共同特征包括ICU临床医生的整合、跨学科方法以及对严重危重疾病的关注。RC结构和过程的异质性有助于未来研究最佳结构和过程，以实现最佳的重症监护综合征和COVID结果的急性后遗症。
The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States. Cross-sectional survey. Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated. None. None. RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%). Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.