Use of intensive care at the end of life in the United States: An epidemiologic study
Use of intensive care at the end of life in the United States: An epidemiologic study
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DOI：
10.1097/01.ccm.0000114816.62331.08
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发表时间：
2004-03-01
影响因子：
8.8
通讯作者：
Rubenfeld, GD
中科院分区：
文献类型：
--
作者：
Angus, DC;Barnato, AE;Rubenfeld, GD
目的：尽管人们关注重症监护病房（ICU）临终护理的适宜性和质量，但美国人在临终时接受ICU护理的人数尚不清楚。我们试图用1999年六个州的出院数据和国家死亡指数来描述美国临终时ICU护理的使用情况。设计：对行政数据进行回顾性分析，以计算临终时使用和不使用ICU的特定年龄住院率，得出全国临终医院和ICU使用情况的估计，并描述ICU死者的特定年龄病例组合。佛罗里达州、马萨诸塞州、新泽西州、纽约州、弗吉尼亚州和华盛顿州的所有非联邦医院。1999年6个州非联邦医院的所有住院病人。干预:没有。测量和主要结果：我们发现1999年6个州有552,157例死亡，其中38.3%发生在医院，22.4%发生在ICU入院后。使用这些数据进行全国估计，每年有54万人在ICU入院后死亡。在生命末期使用ICU的特定年龄比率最高的是婴儿（43%），在年龄较大的儿童和成人中从18%到26%不等，而在85岁以上的人群中下降到14%。ICU终末住院的平均住院时间和费用为12.9天，24,541美元；非ICU终末住院的平均住院时间和费用为8.9天，8,548美元。结论：五分之一的美国人死于ICU服务。到2030年，65岁以上人口将增加一倍，除非卫生保健系统实行配给，更有效的高级护理计划，并增强在其他环境中护理垂死患者的能力，否则将需要在全系统范围内扩大ICU对垂死患者的护理。
Objective: Despite concern over the appropriateness and quality of care provided in an intensive care unit (ICU) at the end of life, the number of Americans who receive ICU care at the end of life is unknown. We sought to describe the use of ICU care at the end of life in the United States using hospital discharge data from 1999 for six states and the National Death Index.Design: Retrospective analysis of administrative data to calculate age-specific rates of hospitalization with and without ICU use at the end of life, to generate national estimates of end-of-life hospital and ICU use, and to characterize age-specific case mix of ICU decedents.Setting. All nonfederal hospitals in the states of Florida, Massachusetts, New Jersey, New York, Virginia, and Washington.Patients. All inpatients in nonfederal hospitals in the six states in 1999.Intervention: None.Measurements and Main Results: We found that there were 552,157 deaths in the six states in 1999, of which 38.3% occurred in hospital and 22.4% occurred after ICU admission. Using these data to project nationwide estimates, 540,000 people die after ICU admission each year. The age-specific rate of ICU use at the end of life was highest for infants (43%), ranged from 18% to 26% among older children and adults, and fell to 14% for those >85 yrs. Average length of stay and costs were 12.9 days and $24,541 for terminal ICU hospitalizations and 8.9 days and $8,548 for non-ICU terminal hospitalizations.Conclusions: One in five Americans die using ICU services. The doubling of persons over the age of 65 yrs by 2030 will require a system-wide expansion in ICU care for dying patients unless the healthcare system pursues rationing, more effective advanced care planning, and augmented capacity to care for dying patients in other settings.