TY - JOUR
T1 - Healthcare utilization and costs in ARDS survivors
T2 - a 1-year longitudinal national US multicenter study
AU - with the National Institutes of Health, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network
AU - Ruhl, A. Parker
AU - Huang, Minxuan
AU - Colantuoni, Elizabeth
AU - Karmarkar, Taruja
AU - Dinglas, Victor D.
AU - Hopkins, Ramona O.
AU - Needham, Dale M.
N1 - Funding Information:
National Heart, Lung, and Blood Institute funded this follow-up study (N01HR56170, R01HL091760 and 3R01HL091760-02S1) and the ARDS Network trials (contracts HHSN268200536165C to HHSN268200536176C and HHSN268200536179C). The funder played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Publisher Copyright:
© 2017, Springer-Verlag Berlin Heidelberg and ESICM (outside the USA).
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Purpose: To evaluate (1) post-discharge healthcare utilization and estimated costs in ARDS survivors, and (2) the association between patient and intensive care-related variables, and 6-month patient status, with subsequent hospitalization and costs. Methods: Longitudinal cohort study enrolling from four ARDSNet trials in 44 US hospitals. Healthcare utilization was collected via structured interviews at 6 and 12 months post-ARDS, and hospital costs estimated via the Medical Expenditure Panel Survey. Adjusted odds ratios for hospitalization and adjusted relative medians for hospital costs were calculated using marginal two-part regression models. Results: Of 859 consenting survivors, 839 (98%) reported healthcare utilization, with 52% female and a mean age of 49 years old. Over 12 months, 339 (40%) patients reported at least one post-discharge hospitalization, with median estimated hospital costs of US$18,756 (interquartile range $7852–46,174; 90th percentile $101,500). Of 16 patient baseline and ICU variables evaluated, only cardiovascular comorbidity and length of stay were associated with hospitalization, and sepsis was associated with hospital costs. At 6-month assessment, better patient-reported physical activity and quality of life status were associated with fewer hospitalizations and lower hospital costs during subsequent follow-up, and worse psychiatric symptoms were associated with increased hospitalizations. Conclusions: This multicenter longitudinal study found that 40% of ARDS survivors reported at least one post-discharge hospitalization during 12-month follow-up. Few patient- or ICU-related variables were associated with hospitalization; however, physical, psychiatric, and quality of life measures at 6-month follow-up were associated with subsequent hospitalization. Interventions to reduce post-ARDS morbidity may be important to improve patient outcomes and reduce healthcare utilization.
AB - Purpose: To evaluate (1) post-discharge healthcare utilization and estimated costs in ARDS survivors, and (2) the association between patient and intensive care-related variables, and 6-month patient status, with subsequent hospitalization and costs. Methods: Longitudinal cohort study enrolling from four ARDSNet trials in 44 US hospitals. Healthcare utilization was collected via structured interviews at 6 and 12 months post-ARDS, and hospital costs estimated via the Medical Expenditure Panel Survey. Adjusted odds ratios for hospitalization and adjusted relative medians for hospital costs were calculated using marginal two-part regression models. Results: Of 859 consenting survivors, 839 (98%) reported healthcare utilization, with 52% female and a mean age of 49 years old. Over 12 months, 339 (40%) patients reported at least one post-discharge hospitalization, with median estimated hospital costs of US$18,756 (interquartile range $7852–46,174; 90th percentile $101,500). Of 16 patient baseline and ICU variables evaluated, only cardiovascular comorbidity and length of stay were associated with hospitalization, and sepsis was associated with hospital costs. At 6-month assessment, better patient-reported physical activity and quality of life status were associated with fewer hospitalizations and lower hospital costs during subsequent follow-up, and worse psychiatric symptoms were associated with increased hospitalizations. Conclusions: This multicenter longitudinal study found that 40% of ARDS survivors reported at least one post-discharge hospitalization during 12-month follow-up. Few patient- or ICU-related variables were associated with hospitalization; however, physical, psychiatric, and quality of life measures at 6-month follow-up were associated with subsequent hospitalization. Interventions to reduce post-ARDS morbidity may be important to improve patient outcomes and reduce healthcare utilization.
KW - Cost
KW - Critical illness
KW - Healthcare
KW - Patient readmission
KW - Quality of life
UR - http://www.scopus.com/inward/record.url?scp=85019702531&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019702531&partnerID=8YFLogxK
U2 - 10.1007/s00134-017-4827-8
DO - 10.1007/s00134-017-4827-8
M3 - Article
C2 - 28550403
AN - SCOPUS:85019702531
SN - 0342-4642
VL - 43
SP - 980
EP - 991
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 7
ER -