May Hua1,2, Michelle Ng Gong3,4, Andrea Miltiades1, Hannah Wunsch1,5,6,7. 1. 1 Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York. 2. 2 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. 3. 3 Department of Medicine and. 4. 4 Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York. 5. 5 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and. 6. 6 Department of Anesthesia and. 7. 7 Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
RATIONALE: Intensive care unit (ICU) patients who receive mechanical ventilation are at high risk for early rehospitalization. Given the medical complexity of these patients, a lack of continuity of care may adversely affect their outcomes during rehospitalization. OBJECTIVES: To determine whether outcomes differ for patients who are rehospitalized at a different hospital versus the hospital of their index ICU stay. METHODS: We conducted a retrospective cohort study of mechanically ventilated ICU patients rehospitalized within 30 days in New York State hospitals between 2008 and 2013. MEASUREMENTS AND MAIN RESULTS: We measured frequency of rehospitalization at a different hospital, mortality, length of stay, and costs during rehospitalization. Of 26,947 mechanically ventilated ICU patients rehospitalized within 30 days of discharge, 8,443 (31.3%) were rehospitalized at a different hospital than that of the index ICU stay. For patients at a different hospital, 13.7% died during rehospitalization versus 11.1% who died at the index hospital (adjusted rate ratio [aRR], 1.11; 95% confidence interval [CI], 1.03-1.20; P = 0.009). Patients who died at a different hospital had shorter length of stay (aRR, 0.80; 95% CI, 0.70-0.92; P = 0.001) and decreased costs (adjusted mean difference, -$9,632.73; 95% CI, -$16,387.60 to -$2,877.88; P = 0.005), whereas survivors of rehospitalization at a different hospital had a modest increase in length of stay (aRR, 1.06; 95% CI, 1.01-1.11; P = 0.009) and increased costs of care (adjusted mean difference, $1,665.34; 95% CI, $602.12-$2,728.56; P = 0.002). CONCLUSIONS: Almost one-third of mechanically ventilated critically ill patients were rehospitalized at a different hospital than that of the index ICU stay. This care discontinuity was associated with increased mortality.
RATIONALE: Intensive care unit (ICU) patients who receive mechanical ventilation are at high risk for early rehospitalization. Given the medical complexity of these patients, a lack of continuity of care may adversely affect their outcomes during rehospitalization. OBJECTIVES: To determine whether outcomes differ for patients who are rehospitalized at a different hospital versus the hospital of their index ICU stay. METHODS: We conducted a retrospective cohort study of mechanically ventilated ICU patients rehospitalized within 30 days in New York State hospitals between 2008 and 2013. MEASUREMENTS AND MAIN RESULTS: We measured frequency of rehospitalization at a different hospital, mortality, length of stay, and costs during rehospitalization. Of 26,947 mechanically ventilated ICU patients rehospitalized within 30 days of discharge, 8,443 (31.3%) were rehospitalized at a different hospital than that of the index ICU stay. For patients at a different hospital, 13.7% died during rehospitalization versus 11.1% who died at the index hospital (adjusted rate ratio [aRR], 1.11; 95% confidence interval [CI], 1.03-1.20; P = 0.009). Patients who died at a different hospital had shorter length of stay (aRR, 0.80; 95% CI, 0.70-0.92; P = 0.001) and decreased costs (adjusted mean difference, -$9,632.73; 95% CI, -$16,387.60 to -$2,877.88; P = 0.005), whereas survivors of rehospitalization at a different hospital had a modest increase in length of stay (aRR, 1.06; 95% CI, 1.01-1.11; P = 0.009) and increased costs of care (adjusted mean difference, $1,665.34; 95% CI, $602.12-$2,728.56; P = 0.002). CONCLUSIONS: Almost one-third of mechanically ventilated critically ill patients were rehospitalized at a different hospital than that of the index ICU stay. This care discontinuity was associated with increased mortality.
Entities:
Keywords:
continuity of patient care; critical illness; hospital readmissions; outcomes research
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