Carolin Fleischmann-Struzek1, Anna Mikolajetz, Konrad Reinhart, Randall J Curtis, Ulrike Haase, Daniel Thomas-Rüddel, Ulf Dennler, Christiane S Hartog. 1. Center for Sepsis Control and Care, University Hospital Jena; Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena; BIH Guest Professorship/Charité Foundation, Department of Anesthesiology and Intensive Care Medicine, Charité University Medical Center, Berlin; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Intensive Care Medicine, Charité University Medical Center, Berlin; Medical Controlling Division, Munich Hospital; Bavaria Hospital, Kreischa.
Abstract
BACKGROUND: Germany has more intensive care unit (ICU) beds per capita than the USA, but the utilization of these resources at the end of life is unknown. METHODS: Retrospective observational study using nationwide German hospital discharge data (DRG statistics; DRG, diag- nosis-related groups) from 2007 to 2015. We investigated hospital deaths and use of intensive care services during terminal hospitalizations. Population-based incidences were standardized to the age and sex distribution of the German population. RESULTS: Standardized hospital admission rates increased by 0.8% annually (from 201.9 to 214.6 per 1000 population), while hospital admissions involving ICU care increased by 3.0% annually (from 6.5 to 8.2 per 1000 population). Among all deaths in the German population, the proportion of hospital deaths with ICU care increased by 2.3% annually (from 9.8% to 11.8%). Among all hospital deaths, the proportion involving ICU care increased by 2.8% annually from 20.6% (2007) to 25.6% (2015). In patients aged 65 and older, the use of intensive care services during terminal hospitalizations increased 3 times faster than hospital deaths. CONCLUSION: Use of intensive care services during terminal hospitalizations increased across all age groups, particularly the elderly. The increased need for end-of-life care in the ICU calls for improvements in educational, policy, and reimbursement strategies. It is unclear whether ICU care was appropriate and compliant with patient preferences.
BACKGROUND: Germany has more intensive care unit (ICU) beds per capita than the USA, but the utilization of these resources at the end of life is unknown. METHODS: Retrospective observational study using nationwide German hospital discharge data (DRG statistics; DRG, diag- nosis-related groups) from 2007 to 2015. We investigated hospital deaths and use of intensive care services during terminal hospitalizations. Population-based incidences were standardized to the age and sex distribution of the German population. RESULTS: Standardized hospital admission rates increased by 0.8% annually (from 201.9 to 214.6 per 1000 population), while hospital admissions involving ICU care increased by 3.0% annually (from 6.5 to 8.2 per 1000 population). Among all deaths in the German population, the proportion of hospital deaths with ICU care increased by 2.3% annually (from 9.8% to 11.8%). Among all hospital deaths, the proportion involving ICU care increased by 2.8% annually from 20.6% (2007) to 25.6% (2015). In patients aged 65 and older, the use of intensive care services during terminal hospitalizations increased 3 times faster than hospital deaths. CONCLUSION: Use of intensive care services during terminal hospitalizations increased across all age groups, particularly the elderly. The increased need for end-of-life care in the ICU calls for improvements in educational, policy, and reimbursement strategies. It is unclear whether ICU care was appropriate and compliant with patient preferences.
Authors: C Denke; U Jaschinski; R Riessen; S Bercker; C Spies; M Ragaller; M Weiss; K Dey; A Michalsen; J Briegel; A Pohrt; C L Sprung; A Avidan; C S Hartog Journal: Med Klin Intensivmed Notfmed Date: 2022-09-28 Impact factor: 1.552