Advance Identification of Patients With Chronic Conditions and Acute Respiratory Failure at Greatest Risk for High-Intensity, Costly Care.
Advance Identification of Patients With Chronic Conditions and Acute Respiratory Failure at Greatest Risk for High-Intensity, Costly Care.
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DOI：
10.1016/j.jpainsymman.2021.11.004
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发表时间：
2022-04
影响因子：
4.7
通讯作者：
Curtis JR
中科院分区：
文献类型：
--
作者：
Khandelwal N;May P;Downey LM;Engelberg RA;Curtis JR
患有慢性基础疾病的患者因急性呼吸衰竭而需要机械通气，面临预后差和费用高的风险。确定重症监护病房(ICU)入院时的特征，以确定高强度、高成本护理的最高风险患者。使用电子健康和财务记录(2011年至2017年)对在学术医疗系统中需要≥48小时机械通气且≥1基础慢性病的患者进行的回溯性队列研究。主要结果为指标性住院总费用。感兴趣的暴露包括慢性病的数量和类型。我们使用有限混合模型来确定成本最高的组。4892名患者符合研究标准。指数住院费用的中位数为135,238美元(范围为9,748美元至3,176,065美元)。有限混合模型确定了三个类别，平均成本分别为89,980美元、150,603美元和277,712美元。2)痴呆(OR：1.55；95%CI：1.17，2.06)或慢性肾功能衰竭(OR：1.27；95%CI：1.08，1.48)；3)入院前一年体重减轻≥为5%(OR：1.25；95%CI：1.05，1.48)；前一年住院(OR：1.92；95%CI：1.58，2.35)。在患有基础慢性病和急性呼吸衰竭的患者中，我们确定了与最高护理成本相关的特征。确定这些患者可能会引起医疗保健系统和医院的兴趣，并可以作为一个迹象，投资于姑息和支持性护理计划，以确保这种护理与患者的目标一致。
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.
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影响因子：
6.3
作者：
Iwashyna TJ;Cooke CR;Wunsch H;Kahn JM
通讯作者：
Kahn JM
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120.7
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van den Boogaard, Mark