Health Care Resource Use and Costs of Two-Year Survivors of Acute Lung Injury An Observational Cohort Study
Health Care Resource Use and Costs of Two-Year Survivors of Acute Lung Injury An Observational Cohort Study
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DOI：
10.1513/annalsats.201409-422oc
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发表时间：
2015-03-01
影响因子：
8.3
通讯作者：
Needham, Dale M.
中科院分区：
文献类型：
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作者：
Ruhl, A. Parker;Lord, Robert K.;Needham, Dale M.
理由：急性肺损伤（ALI）幸存者在出院后需要持续的医疗保健资源。这种资源使用的程度，以及相关的成本，并没有完全understood.Objectives：对于ALL后存活至少2年的患者，我们评估了累积的2年住院和相关费用，以及患者和重症监护室相关暴露与这些费用的关联。在4家学术教学医院的13个重症监护病房进行的多中心观察性队列研究，评价了138名ALL的2年生存者。2年住院医疗保健使用数据（即，通过（1）与患者和/或代理人的一次性回顾性结构化访谈，（2）非联邦研究中心医院的系统性病历审查，和（3）非研究中心医院的住院病历审查，收集生存至少2年的患者的住院情况（住院、专业护理和康复机构），以澄清患者/代理人报告。费用以2013年美元计算。142例2年生存者中共有138例（97%）完成了访谈，其中111例（80%）报告在随访期间至少有一次住院，估计费用中位数（四分位数间距[IQR]）为535，259（10，565 - 81，166美元）。再入院占成本的76%。在评估的12例患者和重症监护室相关暴露中，基线合并症和重症监护室住院时间与发生任何随访住院费用的几率增加相关。医疗保险或医疗补助（与私人保险相比）与估计成本中位数高出85%相关（相对中位数，1.85; 95%置信区间，1.01-3.45;P = 0.045）。在这项对138名ALL两年生存者的多中心研究中，80%有一次或多次住院，代表中位数（IQR）估计费用为35美元，每例患者259美元（10，565 - 81，166美元），整个队列6，598，766美元。再入院占住院总费用的76%，在ALI之前有医疗保险或医疗补助与费用增加有关。随着人口老龄化和合并症的增加，这些发现对重症患者的护理具有重要的卫生政策意义。
Rationale: Survivors of acute lung injury (ALI) require ongoing health care resources after hospital discharge. The extent of such resource use, and associated costs, are not fully understood.Objectives: For patients surviving at least 2 years after ALL we evaluated cumulative 2-year inpatient admissions and related costs, and the association of patient- and intensive care unit-related exposures with these costs.Methods: Multisite observational cohort study in 13 intensive care units at four academic teaching hospitals evaluating 138 two-year survivors of ALLMeasurements and Main Results: Two-year inpatient health care use data (i.e., admissions to hospitals, and skilled nursing and rehabilitation facilities) were collected for patients surviving at least 2 years, via (1) one-time retrospective structured interview with patient and/or proxy, (2) systematic medical record review for nonfederal study site hospitals, and (3) inpatient medical record review for non-study site hospitals, as needed for clarifying patient/proxy reports. Costs are reported in 2013 U.S. dollars. A total of 138 of 142 (97%) 2-year survivors completed the interview, with 111 (80%) reporting at least one inpatient admission during follow-up, for median (interquartile range [IQR)) estimated costs of 535,259 ($10,565-$81,166). Hospital readmissions accounted for 76% of costs. Among 12 patient- and intensive care unit-related exposures evaluated, baseline comorbidity and intensive care unit length of stay were associated with increased odds of incurring any follow-up inpatient costs. Having Medicare or Medicaid (vs. private insurance) was associated with median estimated costs that were 85% higher (relative median, 1.85; 95% confidence interval, 1.01-3.45;P = 0.045).Conclusions: In this multisite study of 138 two-year survivors of ALL 80% had one or more inpatient admission, representing a median (IQR) estimated cost $35,259 ($10,565-$81,166) per patient and $6,598,766 for the entire cohort. Hospital readmissions represented 76% of total inpatient costs, and having Medicare or Medicaid before ALI was associated with increased costs. With the aging population and increasing comorbidity, these findings have important health policy implications for the care of critically ill patients.