重症监护病房高成本患者的特征、结局及成本模式
Characteristics, Outcomes, and Cost Patterns of High-Cost Patients in the Intensive Care Unit.
作者信息
Reardon Peter M, Fernando Shannon M, Van Katwyk Sasha, Thavorn Kednapa, Kobewka Daniel, Tanuseputro Peter, Rosenberg Erin, Wan Cynthia, Vanderspank-Wright Brandi, Kubelik Dalibor, Devlin Rose Anne, Klinger Christopher, Kyeremanteng Kwadwo
机构信息
Division of Critical Care Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
出版信息
Crit Care Res Pract. 2018 Sep 2;2018:5452683. doi: 10.1155/2018/5452683. eCollection 2018.
BACKGROUND
ICU care is costly, and there is a large variation in cost among patients.
METHODS
This is an observational study conducted at two ICUs in an academic centre. We compared the demographics, clinical data, and outcomes of the highest decile of patients by total costs, to the rest of the population.
RESULTS
A total of 7,849 patients were included. The high-cost group had a longer median ICU length of stay (26 versus 4 days, < 0.001) and amounted to 49% of total costs. In-hospital mortality was lower in the high-cost group (21.1% versus 28.4%, < 0.001). Fewer high-cost patients were discharged home (23.9% versus 45.2%, < 0.001), and a large proportion were transferred to long-term care (35.1% versus 12.1%, < 0.001). Patients with younger age or a diagnosis of subarachnoid hemorrhage, acute respiratory failure, or complications of procedures were more likely to be high cost.
CONCLUSIONS
High-cost users utilized half of the total costs. While cost is associated with LOS, other drivers include younger age or admission for respiratory failure, subarachnoid hemorrhage, or after a procedural complication. Cost-reduction interventions should incorporate strategies to optimize critical care use among these patients.
背景
重症监护病房（ICU）护理成本高昂，且患者之间的成本差异很大。
方法
这是一项在学术中心的两个ICU进行的观察性研究。我们将按总成本计算处于最高十分位数的患者的人口统计学、临床数据和结局与其他患者群体进行了比较。
结果
共纳入7849例患者。高成本组的ICU中位住院时间更长（26天对4天，<0.001），占总成本的49%。高成本组的院内死亡率较低（21.1%对28.4%，<0.001）。高成本患者出院回家的较少（23.9%对45.2%，<0.001），且很大一部分被转至长期护理机构（35.1%对12.1%，<0.001）。年龄较小或诊断为蛛网膜下腔出血、急性呼吸衰竭或手术并发症的患者更有可能成为高成本患者。
结论
高成本使用者占总成本的一半。虽然成本与住院时间相关，但其他驱动因素包括年龄较小或因呼吸衰竭、蛛网膜下腔出血或手术并发症入院。成本降低干预措施应纳入优化这些患者重症监护使用的策略。
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