National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr., Room 6240C, Bethesda, MD, 20892, USA.
Outcomes after Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Intensive Care Med. 2017 Jul;43(7):980-991. doi: 10.1007/s00134-017-4827-8. Epub 2017 May 26.
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.
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.
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.
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.
评估（1）ARDS 幸存者出院后的医疗保健利用情况和估计费用，以及（2）患者和重症监护相关变量与 6 个月患者状况之间的关系，与随后的住院和费用之间的关系。
对来自 44 家美国医院的 4 项 ARDSNet 试验的进行了纵向队列研究。通过在 ARDS 后 6 个月和 12 个月进行的结构化访谈收集医疗保健使用情况，并通过医疗支出面板调查估计医院费用。使用边缘两部分回归模型计算住院的调整后优势比和医院费用的调整后中位数。
在 859 名同意参与的幸存者中，839 名（98%）报告了医疗保健使用情况，其中 52%为女性，平均年龄为 49 岁。在 12 个月期间，339 名（40%）患者报告至少有一次出院后住院，估计平均医院费用为 18756 美元（四分位距 7852-46174；90 百分位数 101500 美元）。在评估的 16 个患者基线和 ICU 变量中，只有心血管合并症和住院时间与住院相关，而脓毒症与医院费用相关。在 6 个月评估时，更好的患者报告的身体活动和生活质量状况与随后的随访中住院次数减少和医院费用降低相关，而更严重的精神症状与住院次数增加相关。
这项多中心纵向研究发现，40%的 ARDS 幸存者在 12 个月的随访中报告至少有一次出院后住院。很少有患者或 ICU 相关变量与住院相关；然而，6 个月随访时的身体、精神和生活质量测量与随后的住院有关。减少 ARDS 后发病率的干预措施可能对改善患者预后和减少医疗保健利用很重要。
