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Outcomes after Rehospitalization at the Same Hospital or a Different Hospital Following Critical Illness

Hua, May; Gong, Michelle Ng; Miltiades, Andrea; Wunsch, Hannah

Rationale: Intensive care unit (ICU) patients who receive mechanical ventilation are at high risk for early rehospitalization. Given their medical complexity, a lack of continuity of care may adversely affect outcomes during rehospitalization.

Objective: To determine whether outcomes differ for patients who are rehospitalized at a different hospital versus the hospital of the index ICU stay.

Methods: Retrospective cohort study of mechanically ventilated ICU patients rehospitalized within 30 days in New York State hospitals from 2008-2013.

Measurements: Frequency of rehospitalization at a different hospital; mortality, length of stay and costs during rehospitalization.

Main Results: Of 26,947 mechanically ventilated ICU patients rehospitalized within 30 days of discharge, 8,443 (31.3%) were rehospitalized at a different hospital than that of the index ICU stay. For patients at a different hospital, 13.7% died during rehospitalization versus 11.1% at the index hospital (adjusted rate ratio (aRR) 1.11 [1.03 -1.20], p=0.009). Patients who died at a different hospital had shorter length of stay (aRR 0.80 [0.70-0.92], p=0.001) and decreased costs (adjusted mean difference (aMD) -$9,632.73 [-$16,387.60 to -$-2,877.88], p=0.005), while survivors of rehospitalization at a different hospital had a modest increase in length of stay (aRR 1.06 [1.01-1.11], p=0.009) and increased costs of care (aMD $1,665.34 [$602.12 to $2,728.56], p=0.002).

Conclusions: Almost one-third of mechanically ventilated critically ill patients were rehospitalized at a different hospital than that of the index ICU stay. This care discontinuity was associated with increased mortality. Further investigation should aim to elucidate reasons for differing patterns of care on rehospitalization and strengthen the causal relationship between care discontinuity and subsequent harm.

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Also Published In

Title
American Journal of Respiratory and Critical Care Medicine
DOI
https://doi.org/10.1164/rccm.201605-0912OC

More About This Work

Academic Units
Anesthesiology
Published Here
June 21, 2019