美国 ICU 住院患者的利用情况和结局。

Utilization and Outcomes in U.S. ICU Hospitalizations.

机构信息

Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA.

Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.

出版信息

Crit Care Med. 2024 Sep 1;52(9):1333-1343. doi: 10.1097/CCM.0000000000006335. Epub 2024 May 23.

DOI:10.1097/CCM.0000000000006335

PMID:38780374

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11446502/

Abstract

OBJECTIVES

Despite its importance, detailed national estimates of ICU utilization and outcomes remain lacking. We aimed to characterize trends in ICU utilization and outcomes over a recent 12-year period in the United States.

DESIGN/SETTING: In this longitudinal study, we examined hospitalizations involving ICU care ("ICU hospitalizations") alongside hospitalizations not involving ICU care ("non-ICU hospitalizations") among traditional Medicare beneficiaries using 100% Medicare part A claims data and commercial claims data for the under 65 adult population from 2008 to 2019.

PATIENTS/INTERVENTIONS: There were 18,313,637 ICU hospitalizations and 78,501,532 non-ICU hospitalizations in Medicare, and 1,989,222 ICU hospitalizations and 16,732,960 non-ICU hospitalizations in the commercially insured population.

MEASUREMENTS AND MAIN RESULTS

From 2008 to 2019, about 20% of Medicare hospitalizations and 10% of commercial hospitalizations involved ICU care. Among these ICU hospitalizations, length of stay and ICU length of stay decreased on average. Mortality and hospital readmissions on average also decreased, and they decreased more among ICU hospitalizations than among non-ICU hospitalizations, for both Medicare and commercially insured patients. Both Medicare and commercial populations experienced a growth in shorter ICU hospitalizations (between 2 and 7 d in length), which were characterized by shorter ICU stays and lower mortality. Among these short hospitalizations in the Medicare population, for common clinical diagnoses cared for in both ICU and non-ICU settings, patients were increasingly triaged into an ICU during the study period, despite being younger and having shorter hospital stays.

CONCLUSIONS

ICUs are used in a sizeable share of hospitalizations. From 2008 to 2019, ICU length of stay and mortality have declined, while short ICU hospitalizations have increased. In particular, for clinical conditions often managed both within and outside of an ICU, shorter ICU hospitalizations involving younger patients have increased. Our findings motivate opportunities to better understand ICU utilization and to improve the value of ICU care for patients and payers.

摘要

目的

尽管其重要性不言而喻，但仍缺乏详细的全国性 ICU 使用和结局数据。本研究旨在描述美国最近 12 年来 ICU 使用和结局的变化趋势。

设计/设置：本纵向研究使用了 2008 年至 2019 年的 Medicare 全部 A 部分索赔数据和 65 岁以下成年人商业索赔数据，对 Medicare 中涉及 ICU 护理的住院治疗（“ICU 住院治疗”）和未涉及 ICU 护理的住院治疗（“非 ICU 住院治疗”）进行了研究，纳入了传统 Medicare 受益人群。

患者/干预措施： Medicare 中 ICU 住院治疗为 18313637 例，非 ICU 住院治疗为 78501532 例；商业保险人群中 ICU 住院治疗为 1989222 例，非 ICU 住院治疗为 16732960 例。

测量和主要结果

从 2008 年到 2019 年，大约 20%的 Medicare 住院治疗和 10%的商业住院治疗涉及 ICU 护理。在此期间，ICU 住院治疗的平均住院时间和 ICU 住院时间均有所下降。死亡率和医院再入院率也有所下降，而且 Medicare 和商业保险患者 ICU 住院治疗的下降幅度大于非 ICU 住院治疗。 Medicare 和商业保险人群中 ICU 住院治疗时间较短（2-7 天）的比例均有所增加，这些患者 ICU 入住时间更短，死亡率更低。在 Medicare 人群中，对于 ICU 和非 ICU 都可以治疗的常见临床诊断，尽管患者更年轻，住院时间更短，但在研究期间，越来越多的患者被分诊到 ICU。

结论

ICU 在相当大比例的住院治疗中得到了应用。从 2008 年到 2019 年， ICU 住院时间和死亡率下降，而 ICU 住院时间较短的患者数量增加。特别是对于经常在 ICU 内外管理的临床疾病， ICU 住院时间较短、患者更年轻的情况有所增加。我们的研究结果为更好地了解 ICU 使用情况并提高 ICU 护理对患者和支付方的价值提供了机会。