University of Ottawa, Ottawa, ON, Canada.
Bruyère Research Institute, Ottawa, ON, Canada.
Crit Care. 2017 May 31;21(1):124. doi: 10.1186/s13054-017-1711-4.
Despite the high cost associated with ICU use at the end of life, very little is known at a population level about the characteristics of users and their end of life experience. In this study, our goal was to characterize decedents who received intensive care near the end of life and examine their overall health care use prior to death.
This was a retrospective cohort study that examined all deaths in a 3-year period from April 2010 to March 2013 in Ontario, Canada. Using population-based health administrative databases, we examined healthcare use and cost in the last year of life.
There were 264,754 individuals included in the study, of whom 18% used the ICU in the last 90 days of life; 34.5% of these ICU users were older than 80 years of age and 53.0% had more than five chronic conditions. The average cost of stay for these decedents was CA$15,511 to CA$25,526 greater than for those who were not admitted to the ICU. These individuals also died more frequently in hospital (88.7% vs 36.2%), and spent more time in acute-care settings (18.7 days vs. 10.5 days).
We showed at a population level that a significant proportion of those with ICU use close to death are older, multi-morbid individuals who incur significantly greater costs and die largely in hospital, with higher rates of readmission, longer lengths of stay and higher rates of aggressive care.
尽管生命末期 ICU 使用的费用很高，但在人群水平上，关于使用者的特征及其生命末期的体验，我们知之甚少。在这项研究中，我们的目标是描述生命末期接受重症监护的死者，并检查他们在死亡前的整体医疗保健使用情况。
这是一项回顾性队列研究，研究了 2010 年 4 月至 2013 年 3 月期间加拿大安大略省三年内的所有死亡病例。使用基于人群的健康管理数据库，我们检查了生命最后一年的医疗保健使用和费用。
研究共纳入了 264754 人，其中 18%的人在生命的最后 90 天内使用了 ICU；34.5%的 ICU 使用者年龄超过 80 岁，53.0%有超过五种慢性疾病。这些死者的平均住院费用比未入住 ICU 的患者高出 15511 至 25526 加元。这些人也更频繁地在医院死亡（88.7%比 36.2%），并且在急性护理环境中花费的时间更多（18.7 天比 10.5 天）。
我们在人群水平上表明，接近死亡时使用 ICU 的人中，相当一部分是年龄较大、多病的个体，他们的费用显著增加，并且主要在医院死亡，再入院率较高，住院时间较长，积极治疗率较高。
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