Christian Apfelbacher1, Susanne Brandstetter2, Sebastian Blecha3, Frank Dodoo-Schittko2, Magdalena Brandl2, Christian Karagiannidis4, Michael Quintel5, Stefan Kluge6, Christian Putensen7, Sven Bercker8, Björn Ellger9, Thomas Kirschning10, Christian Arndt11, Patrick Meybohm12, Steffen Weber-Carstens13, Thomas Bein14. 1. Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. christian.apfelbacher@med.ovgu.de. 2. Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, 93051, Regensburg, Germany. 3. Department of Anesthesia & Operative Intensive Care, University Hospital Regensburg, 93042, Regensburg, Germany. 4. Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, 51109, Cologne, Germany. 5. Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, 37075, Göttingen, Germany. 6. Department of Intensive Care Medicine, University Medical Centre, Hamburg-Eppendorf, 20246, Hamburg, Germany. 7. Department of Anesthesiology and Operative Intensive Care, University Hospital Bonn, 53127, Bonn, Germany. 8. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103, Leipzig, Germany. 9. Department of Anesthesiology and Intensive Care, Klinikum Dortmund, 44137, Dortmund, Germany. 10. Department of Anesthesiology and Intensive Care, University Hospital Mannheim, 68167, Mannheim, Germany. 11. Department of Anesthesiology and Operative Intensive Care, University Hospital Marburg, 35042, Marburg, Germany. 12. Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Würzburg, 97080, Würzburg, Germany. 13. Department of Anaesthesiology and Intensive Care Medicine, Charité -University Medicine Berlin, 10117, Berlin, Germany. 14. Department of Anesthesia & Operative Intensive Care, University Hospital Regensburg, 93042, Regensburg, Germany. thomas.bein@ukr.de.
Abstract
BACKGROUND: Significant long-term reduction in health-related quality of life (HRQoL) is often observed in survivors of the acute respiratory distress syndrome (ARDS), and return to work (RtW) is limited. There is a paucity of data regarding the relationship between the quality of care (QoC) in the intensive care unit (ICU) and both HRQoL and RtW in ARDS survivors. Therefore, the aim of our study was to investigate associations between indicators of QoC and HRQoL and RtW in a cohort of survivors of ARDS. METHODS: To determine the influence of QoC on HRQoL and RtW 1 year after ICU-discharge, ARDS patients were recruited into a prospective multi-centre patient cohort study and followed up regularly after discharge. Patients were asked to complete self-report questionnaires on HRQoL (Short Form 12 physical component scale (PCS) and mental component scale (MCS)) and RtW. Indicators of QoC pertaining to volume, structural and process quality, and general characteristics were recorded on ICU level. Associations between QoC indicators and HrQoL and RtW were investigated by multivariable linear and Cox regression modelling, respectively. B values and hazard ratios (HRs) are reported with corresponding 95% confidence intervals (CIs). RESULTS: 877 (of initially 1225 enrolled) people with ARDS formed the DACAPO survivor cohort, 396 were finally followed up to 1 year after discharge. The twelve-month survivors were characterized by a reduced HRQoL with a greater impairment in the physical component (Md 41.2 IQR [34-52]) compared to the mental component (Md 47.3 IQR [33-57]). Overall, 50% of the patients returned to work. The proportion of ventilated ICU patients showed significant negative associations with both 12 months PCS (B = - 11.22, CI -20.71; - 1,74) and RtW (HR = 0,18, CI 0,04;0,80). All other QoC indicators were not significantly related to outcome. CONCLUSIONS: Associations between ICU QoC and long-term HrQoL and RtW were weak and largely non-significant. Residual confounding by case mix, treatment variables before or during ICU stay and variables pertaining to the post intensive care period (e.g. rehabilitation) cannot be ruled out. TRIAL REGISTRATION: Clinicaltrials.govNCT02637011. (December 22, 2015, retrospectively registered).
BACKGROUND: Significant long-term reduction in health-related quality of life (HRQoL) is often observed in survivors of the acute respiratory distress syndrome (ARDS), and return to work (RtW) is limited. There is a paucity of data regarding the relationship between the quality of care (QoC) in the intensive care unit (ICU) and both HRQoL and RtW in ARDS survivors. Therefore, the aim of our study was to investigate associations between indicators of QoC and HRQoL and RtW in a cohort of survivors of ARDS. METHODS: To determine the influence of QoC on HRQoL and RtW 1 year after ICU-discharge, ARDSpatients were recruited into a prospective multi-centre patient cohort study and followed up regularly after discharge. Patients were asked to complete self-report questionnaires on HRQoL (Short Form 12 physical component scale (PCS) and mental component scale (MCS)) and RtW. Indicators of QoC pertaining to volume, structural and process quality, and general characteristics were recorded on ICU level. Associations between QoC indicators and HrQoL and RtW were investigated by multivariable linear and Cox regression modelling, respectively. B values and hazard ratios (HRs) are reported with corresponding 95% confidence intervals (CIs). RESULTS: 877 (of initially 1225 enrolled) people with ARDS formed the DACAPO survivor cohort, 396 were finally followed up to 1 year after discharge. The twelve-month survivors were characterized by a reduced HRQoL with a greater impairment in the physical component (Md 41.2 IQR [34-52]) compared to the mental component (Md 47.3 IQR [33-57]). Overall, 50% of the patients returned to work. The proportion of ventilated ICU patients showed significant negative associations with both 12 months PCS (B = - 11.22, CI -20.71; - 1,74) and RtW (HR = 0,18, CI 0,04;0,80). All other QoC indicators were not significantly related to outcome. CONCLUSIONS: Associations between ICU QoC and long-term HrQoL and RtW were weak and largely non-significant. Residual confounding by case mix, treatment variables before or during ICU stay and variables pertaining to the post intensive care period (e.g. rehabilitation) cannot be ruled out. TRIAL REGISTRATION: Clinicaltrials.govNCT02637011. (December 22, 2015, retrospectively registered).
Entities:
Keywords:
ARDS; Health-related quality of life; ICU; Quality of care; Return to work; Volume
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